Evaluation and healthcare professionals essay

The aim of this assignment is always to explore the four periods of APIE, explaining their very own importance in nursing, and also identifying feasible problems inside the stages, with regards to the videos of Paul. These issues are anaylsed applying theory, to produce possible explanations and effects for the behaviour and actions proven by Paul and the nursing staff. APIE can be described as nursing method which guides health professionals throughout the problem solving strategy, which promotes the individualised, holistic delivery of attention.


It can be tailored around the patient’s demands and permits nurses to holistically assess the patient, in that case plan and set goals based on the information collected. These programs and goals are in that case implemented in to the care delivery and assessed for efficiency (Wilson, 2012). Assessment Analysis requires taking a look at the patient holistically and building what the individual was like before being admitted and what exactly they are like today. If there is any change between two, then the cause of this change has to be identified.

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Once this is founded, a detailed program can be produced to deal with the actual issue and potential problems which can arise consequently. Assessment is very important because it opinions the person since an individual (Barrett, Wilson and Woollands, 2009). The consequences of wrongly assessing a patient are that with the planning level, care might be tailored incorrectly to their sexuality, religion and also other factors that happen to be paramount to that individual. This will likely in turn impact the way care is applied.

An individual’s traditions, values and beliefs are really influential in establishing the particular carer may well do to them and what they prefer to do themselves (Baldwin, Longhurst, Smith, ou al, 2003). Information collected may be target or subjective. Objective info is measurable and identifiable whereas subjective data is determined by the individual to be able to understand their experience (Long, Phipps and Cassmeyer, 1995). In order to validate and confirm the information gathered during analysis, it is crucial to relay the info collected back in the patient (Lippincott, Williams and Wilkins, 2007).

One reason of Joe’s behaviour may be the Cognitive Cacophonie Theory (Festinger, 1954) or in other words that this individual expresses a great idealistic look at by saying that he would not change anything about the rendering of his care and stating that most the nursing staff are wonderful. These statements are contradicted by the fact the nurses usually do not acknowledge him when he consistently asks for his glasses, and in addition they talk over him and dismiss him as he is getting up out of bed. He makes excuses for his or her bad practice by stating that the healthcare professionals are occupied and that regardless of anyway as they does not possess anywhere to go.

Joe can be using intellectual dissonance like a coping technique to maintain a harmonious relationship and avoid the facts (McLeod, 2008). Coping approaches are a way of the individual dealing with their particular problem to create it even more manageable. These strategies, if adaptive or perhaps maladaptive, ought to be identified nevertheless patient interaction in the assessment stage. In the event the coping strategy is maladaptive thenit needs to be identified by nurses and then plans and goals should be set out to locate the cause of this kind of behaviour and how to rectify that. Joe can be using a dealing strategy to handle hisdeterioration in independence, since becoming unmoving, stationary and énurétique.

The reasons behind these concerns occurring should be identified at this stage, before moving on to the planning stage (Barrett et approach, 2009). Physiologically, Joe are at Stage 8 of Erikson’s (1980) Creation which means he should be for a stage where he is evaluating his life and passing in the wisdom to others, however Joe is not able to connect in the home when he is lay alone in meal occasions and is not listened to by the carers. Erikson (1980) states that we continue developing till we expire and that simply by Joe’s stage, all the spirit strengths from your past seven stages come together and are used to evaluate your life.

Upon observation however , it seems obvious that a number of the ego strong points are staying damaged ” will power, goal and self-confidence and fidelity are eroded by the simple fact he is known as “silly thing and ignored when he regularly asks for his glasses. Level Two autonomy is also eroded as he is definitely not given the freedom of choosing him own foods or picking what period he wakes up or feeds on breakfast. This kind of shows that Paul was not examined in accordance with his age.

To rectify this matter, Joe has to be made more autonomous, offered encouragement to usethe revolver instead of a catheter and permitting him for making his very own choices. The government White Newspaper (2006) targets the need for individualised care and calls for in order to be designed around the requires of the individual and never the provider. It should place the specific in control of their very own life and promote self-reliance, by providing a more flexible assistance, with a view into a reaching and fulfilling a healthy old age. In addition , violence, stress and maltreatment which cause a threat to an individual’s overall health, must be determined and dealt with.

The nursing staff did not perspective Joe as an individual since they did not really give him the opportunity to choose what he wished to eat, or allow him to get dressed before leaving his room. To adopt a more individualised approach, the nurses really should have let him choose what tine to stand up in a early morning, allowing him to receive dressed and additional choose what he planned to eat breakfast every day, therefore sticking with The White Paper guidelines. Planning Organizing is important as it clearly sets out SMART Desired goals which are sufferer centered and thus involve the individual directly, when the goals are being founded (Barrett et al, 2009).

A consequence of certainly not involving the sufferer directly or clarifying particulars to the affected person is that the desired goals will not be fulfilled, or desired goals will be established which are irrelevant. Important desired goals may be omitted or create goals will not be good for the individual. A scientific Nursing Medical diagnosis should accumulate information from your patient regarding the consequences of living with their particular condition as well as the impact it has on their life. A way of this, is creating a baseline ” what was the individual like prior to condition arose, and exactly what they just like now.

Furthermore, it should be recognized how the affected person copes with this transform. For example , May well should have been asked what like for him having a catheter. Joe’s daily je?ne routine before wearing a catheter should have recently been established, in order to compare it to his current day to day routine. Then Joe should be asked how he could be coping with this kind of change and exactly how this alter affects his life. Precisely the same method must also have been accustomed to assess his immobility, in order that a needs statement can be written, together with a baseline, to make progress measurable (Barrett ou al, 2009).

Joe accustomed to be able to walk when he was admitted, at this point he is within a wheelchair. He says he cannot get to the toilet on his own, and because of this, his independence have been compromised. The nurses is going to take into account the psychological, sociological and biological implications with this change in flexibility. If APIE, was performed correctly, the cause of Joe’s reduced mobility needs to be established, as well as what can be done to avoid any potential problems arising from immobility just like constipation, oedema, decreased muscle tissue and affected circulation(Carpenito-Moyet, 2009).

A further objective which was not really identified at this time was to maintain Joe’s personality and masculinity by permitting him have on his individual clothes and asking what he planned to wear, because oppose to sitting in pyjamas all day. This is bad practice because sitting in pyjamas throughout the day assumes Paul into The Unwell Role, a Functionalist role identified by Talcott Parsons (1951)as withdrawing from usual social behavior and adopting a more deviant role, which deems these people excluded from your social obligations and regular day to day functioning(Bilton, Bonnett, Williams, Lawson, Skinner, Stanworth and Webster, 2002).

The rns further present signs of this behaviour because they chair Joe alone at lunch break, thus not including him by social interaction. An explanation on this may be the fact that nurses gain a sense of electrical power if they are capable of assume somebody into a unaggressive role, since the sick function gives the registered nurse authority over the patient’s overall health, plus the right to gain private information from them. A result of the nursing staff behaving in this way, may lead to the self-fulfilling prophecy whereby Joe adapts and begins to adapt the sick and tired role which is assumed of him.

This process of conforming to deviance is also called deviance amplification (Bilton ain al, 2002). The reasons to get the carers not placing a goal in this aspect of Joe’s life might be due to the nursing staff not being aware about the implications of sitting someone in pyjamas all day. Another justification may be that the nurses immediately ‘labelled’ Joe as being ill, thus if, perhaps him right into a sick role without pre meditation of accomplishing so. May well may not feel at ease asking to put on his individual clothes in case he is known as being a challenging patient, as a result of sociological expérience that the practitioner is prominent andthe patient must comply with their rulings (Bilton ou al, 2002).

A suggestion to alleviate this problem may be to put a target in place intended for Joe to decorate his own clothes. Implementation Implementation is very important because it puts into action what has become set out in the care plan and in the goal setting procedure. The consequence of certainly not implementing attention properly is that a standardised method of care may be executed as go against sb/sth ? disobey to a holistic method, which usually respects specific requirements and ethnical diversity (Barrett et al, 2009).

The NMC Code (2008) supports this by simply emphasising the need to treat sufferers as persons as well as playing them and responding appropriately. The nurses did not apply Joe’s care properly because they did not really respond to his request for his glasses, which will he called for several times. A possible explanation because of their behaviour could possibly be due to ageist views. To compliment this theory, studies possess highlighted a preference amidst care employees to work with kids or youngsters ” a great ageist view which has triggered older people typically not correctly assessed or receiving comprehensive care.

Overall, this age group often do not benefit from the up most work of medical staff (Gross, 1992). One other theory to describe Joe’s and the nurses’ actions may be explained by the Cultural Disengagement Theory which displays co-operation in the elderly specific in the process of disengagement between them and world. Erikson (1951)guides an individual through life up until old age, from which point, the consumer is left to older and develop by showing on their previous, thus disengaging with their role in society and conforming to a even more submissive position.

(Cumming, Dean and Newell, 1960). A few argue that the ageist look at is validated. A. N. Shaw, of Bradford Noble Infirmary (1994) argues that in an regarding limited health-related, ageism for the elderly is a positive technique in arranging healthcare features for those who will most profit, i. e. the younger generation. This kind of argument on the other hand is certainly not in keeping with the NMC Code (2008) which will states that you have to not provide care which can be discriminatory by any means. A. W. Shaw’s watch however , can be the same perspective adopted by nurses, which may explain their very own behaviour.

The nurses probably will have applied his attention better by using a holistic method to Joe, and not viewing him as another statistic. If the evaluation and planning stages have been one correctly then the execution of his care might have been at a higher standard plus more patient centered. Joe’s undesirable learned conduct is to retain quiet and shut up. He provides learnt this by the fact that every time this individual speaks, he could be ignored. Learning is a procedure which results in long lasting changes in actions. Joe’s catheter (also described in the planning stage) was not checked in the morning.

Joe gripes that his catheter typically gets full and draws. The consequences of not examining his catheter regularly happen to be that indications of dehydration or infection may possibly go unnoticed. The amount of urine should also always be checked since if the quantity is low, it may be that that the catheter is obstructed or blocked (McMillen and Pitcher, 2010). Normal urinary output should be around 30ml per hour. (Colvin, Guffey, Hoelscher and Jones, 2011). The nurses should be familiar with catheter care and really should initiate learning of this kind of procedures, to be able to benefit the person and enhance Joe’s well-being.

Evaluation There are two types of evaluation: summative evaluation and formative analysis. Summative reviews evaluate just how effective the general approach to treatment and the procedure for care were. It can determine whether a alternative approach to treatment was used and how effective the assessment method was in understanding the nursing diagnosis; in order to lead to patient centered organizing regards their needs statements and baselines. Desired goals are also examined in terms of relevance and how practical they were.

Formative evaluations rely on direct doctor to affected person interaction to ascertain whether the trouble has got better or worse. For this to work, a baseline should be in place for every single goal, to be able to assess perhaps the patient provides moved from or for the goal. Individual activity and behaviour are also scrutinised to satisfy this evaluation. Interaction with all the patient, in order to learn about their very own experiences, is vital to this form of evaluation as they know themselves better than anyone Evaluation is very important because it reviews the effectiveness of the existing plan.

If the current plan is not deemed to be beneficial to the individual then it is very important to return to the assessment stage and correct virtually any problems (Barrett et approach, 2009). The consequence of not assessing correctly is that the process offers therefore recently been ineffective in establishing any potential complications with the previous levels. The elderly have different nutritional requirements to more youthful adults because of age related natural changes including changes in metabolism, digestive enzyme ability and changes in the gastrointestinal tract (Long et.

ing., 1995). Upon admission, Paul was asked to write down which foods he liked to consume, yet he can given porridge every day and was told it was his ‘favourite’. The Evaluation Stage should require interaction with Joe to identify whether his needs were met in the last three stages(Long et. approach., 1995). The Evaluation stage here provides therefore recently been unsuccessful as it has not recognized that the examination process is unsucssesful to produce a individual centered breastfeeding diagnosis for his diet plan and liquid intake.

The outcomes of feeding someone that same food daily is that Later on is at likelihood of Protein Strength Malnutrition, onset by limited protein, carbohydrates and fat in the diet, or perhaps vitamin insufficiencies (Waugh and Grant, 2010). The consequences of malnutrition inside the elderly, if perhaps sustained happen to be fatigue, muscle loss as a result of body using muscle to get energy, damaged immune response and body organ function (due to not enough the nutrients required to perform) and eventually fatality (Cope, 1996).

Joe brings up that all he’d like can be described as lovely cup of tea, because when they do provide him a drink, it really is lukewarm, and so he almost certainly does not would like to drink this. The consequences of Joe not really been given a glass or two with his breakfast is that he might become dried up. The elderly have reached an increased risk of dehydration as a result of biological factors such as decreased thirst notion, body drinking water mass, lowered kidney ability and vasopressin, so it is more importantly to evaluate substance intake through this age group, which means nurses needs to be ensuring Joe’s fluid intake meets the recommended recommendations (Lavizzo-Mourey, 1997).

Becoming dried up may also bring about Joe encountering mental dilemma, fatigue, obstipation, loss of urge for food (which is going to contribute to malnutrition), concentrated urine, fatigue and irritability (Denby, Baic and Rinzler, 2006). Oedema is known as a further outward exhibition of dehydration, a problem that could be made worse by simply Joe’s immobility. Other manifestations include confusion (which will be heightened by the fact May well cannot see properly with no his glasses) and if certainly not treated may result in coma.

Neglected, dehydration brings about shock were tissues continue to malfunction and major organs such as the lean meats and renal become broken due to a reduction in circulating blood vessels volume (Rosdahl and Kowalski, 2007). Healthcare professionals should be aware of these signs to be able to recognise if a patient is suffering from lacks and weakness, in order to correct the problem within a safe timescale. Tea is likewise not a suggested drink to give older adults with a meals because it inhibits iron absorption. Low iron levels could potentially cause anaemia, and memory reduction and exhaustion.

His diet plan should therefore be examined to include even more red meat, greasy fish, ova and lunch break cereals which can be fortified with iron. Finding a substitute to drinking tea at meals may also be regarded as at this stage (Denby, Baic and Rinzler, 2006). As maintained the evidence proven above, it could be concluded that the behaviour in the nurses would not support the rules illustrated inside the stages of A. P. I actually. E, and so the nurses possess failed to successfully use a problem solving process.

Info gathered through the assessment level was not sufficient enough to devise suited plans and goals, and so the implementation level failed. Evaluation was as well unsuccessful as it did not discover were the prior stages had gone wrong. Mainly because all of the phases are related, failure in a single stage contains a knock in effect to the other levels (Barrett ou al, 2009). Because the healthcare professionals failed at the assessment stage, it quickly affected all of those other process. 201101791.

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