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Exploring Risk Assessment in Nursing Practice

  • 13 Pages
  • Published On: 8-12-2023
Reflective journal entry 1 (risk assessment):
Reflective journal on risk assessment (COPD)

Reflection is one of the most crucial aspects of nursing practice that assists nursing professionals to analyse their past behaviour, experiences activities, performances, interaction and communication thereby reflecting on their knowledge, strength and weaknesses. In this essay, I will reflect on my experiences and knowledge that I gained on risk assessment as an assistant practitioner by working under the direction of the health professionals. Here I will use Driscoll’s (2007) Reflective Model that assists me to present a comprehensive discussion on the risk assessment of the patient by using the systematic process ‘What’, “So what” and ‘now what’.

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What:

Being an assistant practitioner, I worked under the guidance of senior nurses and other healthcare professionals. I helped senior nurses to provide effective care and support to a patient, John suffering from episodic shortness of breath, chest tightness and severe respiratory issues. Here my main role was to help the nurses in their jobs. After the patient’s admission, I was assigned to help nurses in many ways such as assisting nurses in carrying out the assessment of the patient’s health condition, collecting data on patient’s pre medical history, professional and personal life and genetic history of breathing issues. After the health assessment was done, the HRCT test was carried out. While carrying out this test, I worked under the direction of nurses to check BP, current oxygen saturation level, heart rate and breathing rate of the patient. After carrying out the test I also made physical observation on the patient to ensure that if I noticed any concern, I would inform the nurses.

So, What:

Based on the pre-medical history, generic history, background and current health condition, of John, care professionals identified the need of conducting an effectives risk assessment of John. Here my role was to help nurses in terms of carrying out systematic and effective risk assessment of John thereby determining the possible risks that were associated with his health. Through carrying out this risk assessment nurses were able to analyse the risks associated with his disease (COPD). In nursing risk assessment is highly important to detect the possible risk to the patients and set effective strategies to eliminate all these risks thereby providing safe care to patients (Maguire et al. 2018). Being an assistant practitioner, I worked under the direction of senior nurses in which I collected the information regarding the John’s lifestyles, professional and personal life, his preferences, diet, food habit and exercises. Through collecting all these data, I work on them under the guidance of senior nurses to determine whether there are potential risk factors in relation to the professional and personal life and the lifestyles of John. I also checked the oxygen saturation level and breathing rate on regular basis of the patients under the guidance and direction of the nurses and if there were any abnormalities, I immediately informed that to the nurse in terms of life limiting chances of any risk. Being an assistant practitioner, it was my duty to assist nurses to implement an effective risk assessment tool to determine, manage and eliminate the health risks of critical patients thereby promoting their positive health and wellbeing. Here the care professional had used a most effective and widely used risk assessment tool the NEWS (National Early Warning Score) (Saleh et al. 2018). NEWS is developed in terms of standardising the approach for detecting the clinical deterioration in the critically ill patients in the UK. In case of John, I carried out his complete health assessment under the guidance of the nurses to check his oxygen saturation, respiration rate, temperature, systolic blood pressure and heart rate. Through using NEWS tool, I assisted the nurses to make a clear analysis of the score in each test, which assisted the entre care team to determine the level of deterioration of John’s current health condition.

Pathophysiology of COPD describes that Chronic Obstructive Pulmonary illness or COPD has two main categories such as dyspnoea and chronic bronchitis (Amariei et al. 2019). COPD affects the function of the lung to carry oxygen into the alveoli. In case of patients with COPD like John, the bronchioles have the narrower inner diameter that causes severe obstruction in the entry and exit of the airways to and from the lungs. Under the instruction of senior nurses, I carried out an airways assessment which showed that airway inside the bronchioles was inflamed and also it faced severe obstruction to maintain its natural flow due to smaller diameter of bronchioles which supply a lower level of oxygen to the lung and from the lungs to the different body parts (Kim, 2017). Here I helped nurses and other care professionals in determining many risks that were associated with John’s health condition such as, breathlessness, adverse circulatory function, poor brain function, and reduced function of different body parts due to simultaneously decrease in blood supply.

Now What:

As mentioned by Anzueto. and Miravitlles (2017), the care plan for a critically ill patients needs to be highly relevant to their current mental and physical health condition which will provide them with the type of care and support that the patients need.

As the score of NEWS for oxygen saturation in John is above 3 (87%), it means that John has limited oxygen supply to the lung. Therefore, John is recommended to perform specific aerobic exercises on regular wise. Here I will work under the guidance the senior nurse to teach patients about the right ways to do aerobic exercises. As an assistant practitioner I follow the instruction on the senior nurses and care professionals in terms of providing right health education to John in terms of improving his self-management ability.

Conclusion:

From the overall discussion, it can be concluded that COPD is a chronic health condition that is associated with breathlessness, respiratory dysfunction, poor lung ability, chest tightness, wheezing and gurgling. While it comes to make an effective risk assessment of patients, nursing professionals must be aware of the pathophysiology of the COPD which will assist to implement the effective care plan for the patient.

Reference list:

Amariei, D.E., Dodia, N., Deepak, J., Hines, S.E., Galvin, J.R., Atamas, S.P. and Todd, N.W., 2019. Combined Pulmonary Fibrosis and Emphysema: Pulmonary Function Testing and a Pathophysiology Perspective. Medicina, 55(9), p.580.

Anzueto, A. and Miravitlles, M., 2017. Pathophysiology of dyspnea in COPD. Postgraduate Medicine, 129(3), pp.366-374.

Bodas, M. and Vij, N., 2017. Augmenting autophagy for prognosis based intervention of COPD-pathophysiology. Respiratory research, 18(1), pp.1-8.

Habib, C., Makhoul, A., Darazi, R. and Couturier, R., 2019. Health risk assessment and decision-making for patient monitoring and decision-support using wireless body sensor networks. Information fusion, 47, pp.10-22.

Hajian, B., De Backer, J., Sneyers, C., Ferreira, F., Barboza, K.C., Leemans, G., Vos, W. and De Backer, W., 2017. Pathophysiological mechanism of long-term noninvasive ventilation in stable hypercapnic patients with COPD using functional respiratory imaging. International Journal of Chronic Obstructive Pulmonary Disease, 12, p.2197.

Hikichi, M., Hashimoto, S. and Gon, Y., 2018. Asthma and COPD overlap pathophysiology of ACO. Allergology International, 67(2), pp.179-186.

Hoikka, M., Silfvast, T. and Ala-Kokko, T.I., 2018. Does the prehospital National Early Warning Score predict the short-term mortality of unselected emergency patients?. Scandinavian journal of trauma, resuscitation and emergency medicine, 26(1), pp.1-7.

Kim, E.K., 2017. Pathophysiology of COPD. In COPD (pp. 57-63). Springer, Berlin, Heidelberg.

Maguire, T., Daffern, M., Bowe, S.J. and McKenna, B., 2018. Risk assessment and subsequent nursing interventions in a forensic mental health inpatient setting: associations and impact on aggressive behaviour. Journal of clinical nursing, 27(5-6), pp.e971-e983.

O’Donnell, D.E., James, M.D., Milne, K.M. and Neder, J.A., 2019. The pathophysiology of dyspnea and exercise intolerance in chronic obstructive pulmonary disease. Clinics in chest medicine, 40(2), pp.343-366.

Radovanovic, D., Pecchiari, M., Pirracchio, F., Zilianti, C., D’Angelo, E. and Santus, P., 2018. Plethysmographic loops: a window on the lung pathophysiology of COPD patients. Frontiers in physiology, 9, p.484.

Saleh, S., Plymale, M.A., Davenport, D.L. and Roth, J.S., 2018. Risk-assessment score and patient optimization as cost predictors for ventral hernia repair. Journal of the American College of Surgeons, 226(4), pp.540-546.

Reflective journal entry 2: (communication)
Reflective journal on communication skills (Diabetes Type 1)
Introduction:

In the modern health care field, self-reflection is crucial for health professionals to make continuous improvement in their skills and knowledge. Self-reflection assists health professionals to reflect on their past experiences, performance and behaviours which are important to determine their compatibility, competency level and limitations. As an assistant practitioner, I will reflect on how I worked under senior nurses in terms of maintaining effective communication within the team. Here I helped the senior nurses in terms of maintaining effective communication while taking care of a 10 years old boy, Brian. In this essay, I am going to use the Driscoll’s (2007) reflective model, in which I use the three important stages such as ‘What’, ‘So what’ and Now what in term of presenting a systematic discussion on how I can manage the effective communication framework to provide the best care and support to the patient.

What:

Brian has been admitted with hyperglycaemia, ketonuria and severe weight loss (5 kgs). Here my role was to assist the senior nurses and care professionals in maintaining effective communication system in the care delivery process. Here I was assigned to assist nurses in many ways such as collecting information from mother of Brian about his lifestyles, professional and personal aspect, education, food habit and preferences and then transferred this information to nurses. I used to assist senior nurses and care professionals by transferring all update regarding Brian’s current heath condition, any changes in his health status or any possible risk to him. While working under nurses, I experienced severe mismanagement in maintaining the effective communication system that was needed for the patient to get the proper clinical support. Under NMC (2015), in case of the emergency patient, health professionals must develop an excellent and effective information delivery system that will assist them to make fast access as well as analysis of health assessment reports by the doctors [NMC, 2015]. Here I faced difficulties in collecting and transferring the important information regarding Brain’s health due to lack of information sharing system and poor coordination between the nurses and care professionals. On the other hand, I was instructed by nurses to form an electronic document in which I mentioned all the health-related information of Brain. Due to my poor written communication skill, I failed to make a clear and understandable document. This event made me realise that I needed to work on my written communication skill.

So, what:

From the above-mentioned incidents, I have learnt the manifold importance of an effective communication framework in the healthcare.

While assisting nurses in terms of maintaining effective communication in the workplace I realised that in case of critical patients like Brian, there must be a fast and clear communication among the health professionals, patients and patients' family members (Palermo et al. 2017). In case of Brian, I felt that I needed to focus on forming clear interaction with him and his mother regarding gathering the details of his premedical history, background, genetic history and his lifestyles, which are highly important for setting an effective care regime for diabetes patient. Nurses must know the pathophysiology of diabetes to plan an effective communication with patients (Corbin et al. 2018.). Pathophysiology of diabetes type 1 shows that, this health condition occurs when the immune system of body attacks the insulin producing beta cells that are located in the Islets of Langerhans of pancreas. Insulin is an important hormone that maintains blood glucose level at a normal range. While there is increase of blood glucose, beta cells are stimulated which then secrete the insulin into blood. Insulin then converts the extra glucose in blood into glycogen which is then stored into the muscle and tissues (Palermo et al. 2017). But in case of diabetes type 1, due to the lack of insulin in the blood, the amount of blood glucose increases. During my role in transferring information regarding patient’s health and treatment to nurses, I realised the importance of both the written and verbal communication in terms of meeting needs u a critical patient (Pappa et al. 2018.). in Brian’s case, nurses could use of a questionnaire on determining whether Brian suffered from lack of apatite, fatigue, hyperventilation, dehydration (caused due to removal of excess water and electrolytes from the body) and blurred vision which are the common symptoms of Types 1 diabetes in children.

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Now What:

By reflecting on the experiences that I gathered throughout my journey as an assistant practitioner , I can say, that in case of Brian, the most important communication tool that nurses could apply is the Ask-Tell-Ask tool (Milano et al. 2017), which can assist them to ask Brian and his mother about his current health condition, premedical history, background, regular lifestyles and food habits and the tell or discuss with them the effective care plan thereby guiding them about how to carry out self-management and then again ask Brian about if he feels better with the currently implemented care plan (Palermo et al. 2017).

Here I can also recommend that while dealing with critical patients care professions must develop as effervesce information delivery system I which they can get all the important updates regarding patient’s health and wellbeing. By racketing on my working journey as an assistant practitioner I can say that, I must work on improving my written communication skill to form a clear ad accurate case study or health related document of patients. It is also recommended that nurses and care professionals must consider that whether patients have the metal and physical ability to involve in effective communication with care professional.

Here I also realise that there must be a quick and systemic information delivery system among the health and nursing professionals that would help them to make the synergistic discussion on implementing effective care strategies in Brian’s case to improve his overall health condition.

Conclusion:

From the overall discussion, it can be concluded that type 1 diabetes is the chronic health condition, that is common in children less than 12 years across the UK. Therefore, the effective communication tool is important to be used by the nursing and health professionals to determine the current health needs of patients with type 1 diabetes and implement the effective care plan to meet these needs.

Reference list:

Corbin, K.D., Driscoll, K.A., Pratley, R.E., Smith, S.R., Maahs, D.M., Mayer-Davis, E.J. and Advancing Care for Type 1 Diabetes and Obesity Network (ACT1ON), 2018. Obesity in type 1 diabetes: pathophysiology, clinical impact, and mechanisms. Endocrine reviews, 39(5), pp.629-663.

Corbin, K.D., Driscoll, K.A., Pratley, R.E., Smith, S.R., Maahs, D.M., Mayer-Davis, E.J. and Advancing Care for Type 1 Diabetes and Obesity Network (ACT1ON), 2018. Obesity in type 1 diabetes: pathophysiology, clinical impact, and mechanisms. Endocrine reviews, 39(5), pp.629-663.

Kelsey, R., Manderson Koivula, F.N., McClenaghan, N.H. and Kelly, C., 2019. Cystic Fibrosis–Related Diabetes: Pathophysiology and Therapeutic Challenges. Clinical Medicine Insights: Endocrinology and Diabetes, 12, p.1179551419851770.

Milano, S., Carmosino, M., Gerbino, A., Svelto, M. and Procino, G., 2017. Hereditary nephrogenic diabetes insipidus: pathophysiology and possible treatment. An update. International journal of molecular sciences, 18(11), p.2385.

Palermo, A., D’Onofrio, L., Buzzetti, R., Manfrini, S. and Napoli, N., 2017. Pathophysiology of bone fragility in patients with diabetes. Calcified tissue international, 100(2), pp.122-132.

Palermo, A., D’Onofrio, L., Buzzetti, R., Manfrini, S. and Napoli, N., 2017. Pathophysiology of bone fragility in patients with diabetes. Calcified tissue international, 100(2), pp.122-132.

Pappa, E., Vastardis, H., Mermelekas, G., Gerasimidi-Vazeou, A., Zoidakis, J. and Vougas, K., 2018. Saliva proteomics analysis offers insights on type 1 diabetes pathology in a pediatric population. Frontiers in physiology, 9, p.444.

Plows, J.F., Stanley, J.L., Baker, P.N., Reynolds, C.M. and Vickers, M.H., 2018. The pathophysiology of gestational diabetes mellitus. International journal of molecular sciences, 19(11), p.3342.

Skyler, J.S., Bakris, G.L., Bonifacio, E., Darsow, T., Eckel, R.H., Groop, L., Groop, P.H., Handelsman, Y., Insel, R.A., Mathieu, C. and McElvaine, A.T., 2017. Differentiation of diabetes by pathophysiology, natural history, and prognosis. Diabetes, 66(2), pp.241-255.

Skyler, J.S., Bakris, G.L., Bonifacio, E., Darsow, T., Eckel, R.H., Groop, L., Groop, P.H., Handelsman, Y., Insel, R.A., Mathieu, C. and McElvaine, A.T., 2017. Differentiation of diabetes by pathophysiology, natural history, and prognosis. Diabetes, 66(2), pp.241-255.

Appendices
Appendix 1:
Pathophysiology of COPD:
Pathophysiology of COPD
Appendix 2:
Pathophysiology of diabetes:
Pathophysiology of diabetes
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