Assessment and care management free essay sample

This reflection essay is going to forms on an assessment tool that uses in my work setting of healthcare delivery. Reflexive exercise, which includes reflexivity that assists the development of emotional intelligence(Grainger 2010). It will use Gibbs(1969) reflective cycle to explain one of the areas where I found myself incompetent with the use of a pain assessment tool. Even though there are variety model of reflective writing Gibbs model is ideal and permitting for explanation, analysis and valuation of the experience helping the reflective personal to make sense of the incident and examine their works. To maintain the confidentiality of the persons according to Nursing and Midwifery Council (2008) it uses fictional names. First part of Gibbs cycle is description of the event. I am a student in BSC Honours in Nursing and Healthcare course in a university. When working in a nursing home with most of dementia patients, the sister in charge showed one Pain Assessment In Advanced Dementia (PAINAD) tool (Appendix 3) and explained it. She said fill that form by assessing the residents. As I am new in that healthcare setting I asked one of my colleagues for assistance. He introduced that form to me more deeply and told to assess the patient for five minutes before filling the form. I assessed one cognitively impaired patient with the PAINAD tool(Corbett, 2012). The next stage of Gibbs reflective cycle is feeling. I was happy to use that tool, because that was my first time using PAINAD tool. However, I was embarrassed and confused too as it was not customary in my practice I felt shame on me as a nurse. N. M. C (2008) states that all nurses should be competent in their work set up. I thought about importance of this tool since advanced dementia patients do not have the ability to communicate effectively (Scott,2012), which is supported by Chatterjee(2012). Thus it is important to assess their silent pain and is the responsibility of healthcare professionals. I also thought that why does this tool need five minute monitoring, and who formulated this tool, so I decided to check for it. Gibbs Reflective cycle’s third level is evaluation. As the residents with dementia lack the communication ability they cannot express their pain and agitation verbally (While,2009), thus finding their unspeakable needs is the responsibility of those who care for them. If the pain left untreated the condition of the resident may get worse with aggression , lack of socialisation and sleep deprivation(While,2009). Corbett (2012) states that correct management of pain is essential for the patient as well as the staff, since it provides easiness of care. It is also should be taken in to consideration that at least 79 percent of dementia patients have any kind of painful condition (Zieber, 2005). Thus the importance of assessing pain through their various expressions was clear to me. Analysis of the situation is the fourth element of Gibbs cycle. I analysed topics I have read and recounting that in the fourth stage of Gibbs cycle. Even though there are many methods to determine the pain, I found that PAINAD is one of the effective one. Chatterjee(2012) states that a major portion of elderly people affect with pain and cognitive impairment before death. The health care professionals need to ask the susceptible person about pain using different words and gestures such as aching, hurting, uncomfortable (SCIE,2009). However, Scherder(2009) and Scott (2012) states that in advanced dementia stage patients lose their linguistic and self care ability which pointed to the importance of assessing pain through various expressions. Herr et. al. (2010) describing as much as 14 pain assessment tools using in health care setting and found that PAINAD by Warden et al(2003) received the highest rating. Six behavioural aspects with a score of zero to two are using in Pain Assessment in Advanced Dementia Tool (Appendix 1). Chatterjee(2012) pointed that PAINAD(Warden et. al,2003) does not provide data on patients complaints where as it only focused on activities of the person. He further states that self reported pain is the most reliable one. If it is found that the person lacks the ability to self report, an observation scale should be used to determine the pain (While,2009). The situation makes me think over the studies conducted about pain assessment tools and its importance in dementia patient care. As pain is a subjective feeling (While,2009) it is hard to assess and manage (Corbett et. al,2012). Thus obtaining the presence and intensity either by assessing activities or by direct reporting may not give excellent result in cognitively impaired patients, however using a combination of tools providing both subjective and objective data should be useful(Chatterjee,2012; Corbett,2009). The reading of articles helped me as a care promoter to assess and manage with residents who are cognitively impaired and susceptible to pain. Even though at first the situation made me embarrassed, I could gain enormous knowledge secondary to that. The incident helped me to understand more about Dementia and need of pain assessment in those dementia patients. Action plan for the future is the last stage of Gibbs reflective cycle. I realised the importance of gaining and updating knowledge day by day since there is new inventions and methods in healthcare sector and planned an action plan (Appendix 2). Healthcare sector is improving and becomes more evidence based to deliver accurate care to patients. N. M. C(2012) persuades nurses to improve up to date their knowledge and skills throughout the career. It also declare that nurses should have the knowledge and skills for safe and effective practice while working. So I decided for continual reading and collaborating my practice with evidence based theories. I decided to participate in appropriate study sessions and practice workshops to attain more knowledge to my career (N. M. C,2012). I planned to assess each residents who belongs to me in each shifts, so I could know their unspeakable feelings and pain. I determined to use both subjective as well as objective data get from each one for this purpose. Cognitively impaired people should be given extra assistance to describe their pain experience through the use of suitable adapted tools, modified to allow for sensory and cognitive insufficiency in the patient and selected to suit their capabilities(Chatterjee,2012). The incident in the new work atmosphere helped to reflect on it and to acquire knowledge to my profession.