This essay will focus on the care plan and the assessment needs of an adult patient who

was admitted to the medical ward due to Chills, Pain, Shortness of breath, increased work
of breathing, Nausea, Cough, Phlegm, Elevated temperature, Low temperature (not as
common), Vomiting, Loose stool, Mental status changes, Increased or decreased
respiratory rate (Pneumonia). The patient also has swallowing difficulties and hearing
impairment plus past medical history of dementia. The first part of the essay will define
communication and discuss the communication theories used when caring for the patient
and its importance when working in multidisciplinary teams. It will also explain how
respect, empathy and dignity are demonstrated by the nurse when providing care. And
the second part will define the nursing process; explain the assessment needs and care
planning problems such as eating and drinking and mobilizing patients using Roper,
Logan and Tierney’s activities of the model. The essay will conclude with a reflection on
personal and professional development from being involved in care planning of a patient
on the ward.

In nursing practice, nurses and midwives owe a duty of confidentiality to all those who are
receiving care when patients disclose personal information and expect that information to
be held confidence Griffith and Tengnah (2017) and this is reinforced by NMC Code
(2015). Therefore, respecting patient’s right to privacy and confidentiality the name and
hospital ward will be withheld in the essay.

According to Almond and Yardley (2009) communication is defined as a process of

interaction, understanding and meaning, that is to say the message is sent from one
person and is received by another individual. The goal of communication is to create a
mutual understanding of the meaning of a message (Burton and Ludwig 2015). Nurses
can achieve this through use of nonverbal and verbal communication.

Furthermore Burton and Ludwig (2015) states that nonverbal communication is

communicated by use of facial expressions, posture and body language. It communicates
more of what the patient feels and thinks than what is said in words. Meanwhile verbal
communication is a conscious use of words either written or spoken. Nurses and patients
choice of words may be dependent on education, age and culture. Meaning feelings can
be expressed verbally through speaking clearly and changes in pace and tone of voice.
It is always important for the nurses to introduce themselves and clarify with the patient
how their preferred to be addressed. This makes them feel valued and respected (Sully
and Dallas, 2010).

According to Middleton, A et al (2010) the majority of patients with hearing loss difficulties
are at risk of not being able to communicate effectively with their nurse and this may affect
the patient care and right to participate actively in decisions about their healthcare.
Effective communication with the patient is vital for patient safety and can improve the
patient’s wellbeing on the ward (Bach and Grant, 2015).

Middleton, A et al (2010) stated that even when the nurses ensure the patient has hearing
aids and active listening skills. It is important for the nurse to communicate effectively
with the patient in the communication process on very occasion to void the challenges
and language barriers. For example, call the patient’s name to attention before speaking.
This reduces the chances of missing words at the beginning of the conversation.

Ensure the patient knows what is being discussed, face the patient while talking directly,
on the same level and in good light whenever possible and in good position; speak clearly
with adequate volume on the side of the hear where the patient hears properly (Bach and
Grant, 2015).

Maintain eye contact sit or stand on the same level as the patient to show that you are
willing to listen (Pavord and Donnelly, 2015). Do not cover your mouth while speaking
and ensure the patient has fully understood by asking leading questions or to ask the
patient to rephrase what’s being said. If the patient has not understood try to rephrase
the words in the different way rather than repeating the same words over and over (Sully
and Dallas, 2010).

The impaired patient can sometimes struggle to understand in a noisy ward for example
in open ward. Using a quieter room can be useful and also using picture messages and
signposting can help the patient to communicate their needs and come over the barriers
(Bach and Grant, 2015).

Nurses should be aware of culture sensitive when using body language and gestures, as
may have varying significance in different culture. This may affect the patient’s
communication patterns and the quality of the care received. Hence they may delay or
reject needed health care services (Burton and Ludwig, 2015). The NMC (2015) 7.3 also
emphasizes nurses to use a range of verbal and non-verbal communication methods,
and consider cultural sensitivities, to better understand and respond to people’s personal
and health needs.

When the nurse communicates with the family members about the patient care or update
it is important to remember the primary duty of confidentiality is to the patient. The patient
will need to know what you intend to discuss with their family before they can give
informed consent for example medical history that regards to current illness but may be
sensitive to the patient.

Therefore it’s vital to seek consent from the patient before giving out any information
concerning their care (reference).ƒ

Furthermore as a nurse try also to have discussions with family members in the presence
of the patient. This will avoid confusion arising from different interpretations of what you
have said. Some patients may feel angry if they believe their family has been given a
different explanation from the one they received (reference)

In addition, effective communication between the patient and multidisciplinary team plays
a vital role in promoting the continuity and clarity of care as well as and patient safety for
example doctors, nurses, dietitians and occupational therapy. It involves Good record
keeping where entries of patient’s records must be clearly and accurately documented.
However, lack of effective communication may cause medical errors that can lead to
potential severe injury (Ndoro, 2014).

According to pavord and Donnelly (2015) Empathy is defined as the ability to ‘’sense the
patient’s world as if it were your own’’. Active listening is the best way to demonstrate
empathy to the patient for example going through pain or fear. The patient may want to
be reassurance what they are worried about. It involves listening with purpose, maintain
eye contact and sit facing the person putting in mind cultural sensitive as some patients
feel it's rude. It also requires the nurse to paraphrase what the patient has said to show
that you understood the content and reflecting back your emotions as it helps the patient
better understand and control their own feelings.

According to Gallagher (2007) respect is an active value that one holds. Make sure that
the patient has privacy by closing the door and window or closing curtains on open ward,
always be polite and acknowledge the patient’s concerns, anxieties and fears without
non-judgmental.

Dignity: always make sure patients are asked how they prefer to be addressed and
respect their wishes; give patients information about their care in time and in a suitable
format for example use appropriate language and no use of jargon and always ask, don’t
assume what your patients want because of their culture and ability for example
encourage them to make their own choice and Involve them in decisions relating to their
care

.According to Bach and Grant (2015), the use of nonverbal communication can be used
to pick up messages from body language which nurses must recognize when patients are
in distress or anxious and respond effectively using therapeutic principles to promote their
wellbeing and manage personal safety.

Therapeutic Communication

Therapeutic communication, in short, is an interaction between a nurse and a patient

that helps advance the physical and emotional health of the patient. Therapeutic
communication is an active process. The nurse uses various strategies to help the
patient express their ideas and feelings in a manner that establishes respect and
acceptance. This, in turn, enhances the patient's comfort levels, encourages a feeling of
safety, and increases their trust in the nurse. That's because good therapeutic
communication helps the patient feel that someone truly understands and cares for
them.
Reference

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Coles, L and Marjoram, B. (eds). Essential Skills Clusters for Nurses: Theory for Practice.
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Bach, S. and Grant, A. (2015) Communication and Interpersonal Skills in Nursing.3rd edn.
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Burton, M. and Ludwig, L. J. M. (2015) Fundamentals of Nursing Care: concepts,

Connections and Skills. 2nd (eds). Philadelphia: F.A. Davis Company.

Gallagher, A. (2007) ‘Nursing ethics’ Sage Journals 14(3) pp360-371 Accessed:17 march
2018.

Griffith, R. and Tengnah, C. (2017) Law and Professional Issues in Nursing. 4th edn.
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Middleton, A., Niruban, A., Girling, G., and Myint, p. k. (2010), ‘Communicating in a
Healthcare Setting with People who have Hearing loss’, British Medical Journal, 341(293)
Accessed at 14 April 2018.

Ndoro, S. (2014) ‘Effective multidisciplinary working: the key to high-quality care’, British
Journal of Nursing, 23(13) Accessed at 18 April 2018.

Sully, P. and Dallas, J. (2010) Essential: Communication Skills For Nursing Midwifery.
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