Needs Assessment in Nursing

This assignment will briefly look into the process of assessment in nursing and methods in carrying out assessments while providing a holistic and person-centred care for the patient. In this assignment, Carl will be introduced and his needs will be assessed and further discussed.

Assessment begins when the nurse collects information from a patient upon admission. This assessment provides an insight to the nurse regarding the patient's diagnosis and allows clinical judgement to be made. The importance of assessing a patient's needs is deemed significant as assessment is a way of determining the care or services an individual patient needs. Assessment ascertains and explores the different services and treatments available to the patient in order to provide the proper care that patient needs (Gulanick et al., 2007).

Healthcare assessments however, are not focused on the individual's medical needs alone, but aim to take into account every aspect of the patient's life. Nurses aim to provide a patient-centred assessment in order to provide a holistic care. A patient-centred assessment not only focuses on the service user's illness or disability but on other aspects of his/her life, such as their culture, religion, work, family, friends, personal views and beliefs. This enables the healthcare professionals to collaborate with the patient in identifying their needs and the type of treatment the patient prefers (Field and Smith, 2008).

The Nursing Midwifery Council further emphasizes the importance of providing a holistic, person-centred and systemic assessment of a service user's physical, emotional, psychological, social, cultural and spiritual needs. They also highlighted the significance of taking responsibility in collaborating with not only the patient but also the multi-disciplinary team and carers/family of the patient in order to ensure that the quality of care is at its highest (NMC, 2010).

Assessment is part of the nursing process and is done through structure. Models of assessment are implemented in order to give a theoretical structure in order to provide an understanding in assessing, addressing and communicating goals, needs and therapy for the patient (Hamilton and Price, 2007). In order to carry out a more systemic way of assessing, Matthew (2010) states that it is best to use the Five steps of nursing process; Assessment, Nursing Diagnosis, Planning, Implementation and Evaluation. This systemic way of assessment enables the nurse to be organised in prioritising patient care without overlooking important information.

As aforementioned, this assignment will focus on Carl who is a 68 year old male. He lives with his wife whom he has been married to for 45 years. He has 5 grown children and 8 grandchildren. Carl is a retired bus driver who smokes 20 cigarettes per day but is a non-drinker. Carl's wife reports of his increased forgetfulness recently. Even a routine trip to the local supermarket is a task for him as he doesn't remember the way home from the store. As a result of his forgetfulness, Carl has been frustrated and agitated lately and has been taking it out on his wife. An even enjoyable activity such as reading bedtime stories to his grandchildren has caused Carl to be irritated due to no picture recognition. These recent happenings have been difficult for Carl's wife to manage. Carl's recent vital signs observations show that his blood pressure is 168/105 mmHg, respiratory rate is 20 rpm, pulse is 92 bpm, SpO2 is 95% and his BMI is at 32 kg/m2. His current medications are Statin, betablocker, aspirin and furosemide.

In order to effectively carry out an assessment, the Royal College of Nursing (RCN) believes that a thorough assessment should be based on Roper, Logan and Tierney's nursing model of 12 activities of daily living. The RCN states that a patient's overall health assessment should relate to the person's ability to undertake these daily living activities in order to assess the service user's health status which can be linked to the medical diagnosis (RCN, 2004). Barrett et al (2012) reiterates that the 12 activities of daily living by Roper, Logan and Tierney are maintaining a safe environment, communicating, breathing, eating and drinking, eliminating, personal cleansing and dressing, controlling body temperature, working and playing, mobilising, sleeping, expressing sexuality and last but not least, dying. In order to assess Carl's needs, his assessment will be carried out using the model mentioned above including any assessment tools needed in implementing his care.

According to Dougherty and Lister (2008), a person's normal respiration rate ranges from 12-18 and approximately 95-98% for a normal arterial oxygen saturation. In reference to Dougherty and Lister, Carl's breaths per minute are slightly above average. Looking at breathing as his first point of assessment, it will need to be monitored and documented using the Early Warning Score (EWS) tool (Mann and Bowler, 2008). Another assessment that could be carried out with Carl is a peak flow. Peak flow is a measurement of the maximum amount at which air can be expelled from the lungs using a peak flow meter (Booker, 2004). Patients are able to perform the procedure themselves at home. Three readings are taken and the best of three is documented in a graph form to be reviewed by either the GP or healthcare professionals within the community (DWP, 2008). It has been mentioned that Carl is a smoker, smoking approximately 20 cigarettes a day. As per NICE (2008) guidelines, it is the healthcare provider and professional's responsibility to provide support and advice in helping him to quit. There are smoking cessation services he could be referred to, GP's and other practitioners in the surgeries as well as in the community who would be able to offer brief interventions and counselling.

Carl's blood pressure would also need to be regularly assessed. Moreover, his heart rate as well as his body temperature will also need to be monitored. These may be documented in addition to his breathing rate, on the EWS tool (Wirral Community NHS, 2011).

Secondly, providing the circumstance Carl is in, his environment internally and externally must also be assessed. His forgetfulness is increasing causing him to become more frustrated and anxious. The fact alone that he sometimes forgets his way home from the local store already poses a threat in maintaining a safe environment to him. Guidance and support from family and healthcare professionals are crucial to him at this stage. As stated by NICE Guidelines (2011), it is important to work with the patient and their family in a way that is non-judgemental when they are suffering with anxiety in order for them to feel comfortable