In this development account I will discuss the skills that I have acquired and developed in assessment of the service user in relation to the competencies. As a Trainee Assistant Practitioner, I work within two district nursing teams that also consist of other multidisciplinary teams. I have chosen three competencies and will discuss each one in relation to my role. The first competency is regarding my knowledge on equality and diversity; I will show how I act in a way that recognises diversity in terms of peoples expressed preferences, choices and gender while demonstrating an individualised approach to the service user. My second competency surrounds health and safety and how I identify a range of emergencies where help needs to be summonsed. My third competency is service improvement; this competency is about demonstrating a willingness to discuss changes that need to be made to my own role, practice and rationale for them. I will identify all these competencies, and the knowledge I have gained and learnt with regard to social, psychological and cultural needs of the service user in relation to the competency. In accordance with the Nursing and Midwifery Council (NMC) Code, if I use a service users name I would not be respecting their right to confidentiality so therefore a fictitious name will be used.
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Firstly I will explain my knowledge and understanding of why I act in a way that recognises diversity in terms of peoples expressed beliefs, preferences, choices and gender while demonstrating an individualised approach to the service user. “Providing dignified care is at the very heart of nursing and is the responsibility of everyone that works within a nursing team, regardless of their role, grade or discipline, dignity is, effectively, everybody’s business and everyone can influence for dignity and care” Royal College of Nursing (2009:2).As discussed by Watling et al, communication can be slowed down by environmental and physical factors; for example, service users with disabilities, cultural differences, and language barriers etc. Within any working environment you will always experience tensions arising between ones values and others. As an example, I work within a multi-cultural are, where most of the population are Asian minority. When I arrived to see this lady, there was no family present, and she spoke very little English. It was very difficult to communicate with her and frustrating for both of us, but luckily a neighbour called round. I asked this neighbour to tell my patient that I would arrange for an interpreter to be present for future visits. It was important for me to respect the patient’s confidentiality, whilst using the neighbour to interpret for me. Through doing so, I was working in a beneficent way. What I have learnt and from studying this module is that whilst carrying out assessments, I need to separate my values from those of other people, and recognise the individual’s rights and responsibilities as long as the individual’s wish does not cause harm to him or her or to others, I must respect their right to choice. Within the principles of good practice as a trainee assistant practitioner, I need to ensure individuals are treated equally but differently and also continue with the trusts training courses on equality, diversity, and conflict resolution and educate others on gaining more knowledge and skills in this area. NHS choices states “Equality Act 2010 gives the NHS new opportunities to work towards eliminating discrimination and reducing inequalities in care”. (2010). I have also learnt It is my responsibility as a trainee assistant practitioner, to ensure that I keep updated on policies, procedures, and legislation. I also need to make time to sit back and read through them regularly to improve my knowledge and assessment skills and to allow me to educate others.GP, (2010), “If you are uncertain about the clinical assessment you should request a second opinion and ensure you keep detailed records of the decisions taken”. It’s also my responsibility as a trainee assistant practitioner to document in a patients care plan all accurate information on the care I have given to them and communicate with a report on all my patients back to the senior nurse in charge that day.
Secondly, I will discuss my ability to identify a range of emergencies where help needs to be summonsed. Since working as a Trainee Assistant Practitioner, I have improved my assessment skills in a range of areas, for example, whilst my mentor and I were visiting a diabetic patient of mine on daily insulin, we found them to be having a hypoglycaemic episode. “Deceased blood glucose below 50mg% manifesting a tremor, sweating, weakness, etc”. McGraw-Hill (2009:337). This lady was experiencing confusion, visual disorders and sweating profusely, it was very obvious to me and my mentor this lady was experiencing hypoglycaemia. I immediately went straight to the fridge where I knew she kept an emergency kit of glucagon oral. Whilst I was doing this my mentor did her blood glucose levels which were 1.1mmols, so we administered the oral glucagon and within minutes my client was feeling a lot better with no more confusion gradually becoming back to her normal self. As a HCA my knowledge about the care of a diabetic client was very basic. Now as a trainee assistant practitioner I have learnt through studying this module how to assess clients holistically. Budgen, V, talks about the importance of “taking a holistic approach and accounting for the needs of the individual” (2005).Through in house training, I now understand what high and low blood sugar levels mean and when to administer/not administer insulin. I also now know to emphasise the importance of a good diet and fluid intake. I have learnt to identify psychological needs as I did with this client who has lived on her own now for ten years and has suffered with depression in the past , Faulkner, A (2001:147)”In assessing a patients concerns, clues may be given that will lead to further questions that will establish if depression is present”. My assessment skills have improved significantly since working with a registered nurse once a week, and spending some time with the community matron, for example, falls assessments and the referral process, wound assessments and the importance of reporting the simplest of wounds to the senior nurse in charge that day. I have learnt to identify that Communication and best practice is all about careful assessment of both physical, psychological health of a patient and also documentation and accurate feedback to team members who delegate to me. Ingram, P (2009:41), Bith (1998)”noted that the main purpose of records is to provide good communication among health professionals, although it can also be extremely useful in defending a nurse (healthcare assistant) in the event of complaint or claim”. I have learnt the importance of accurate, up to date care plans. So that all team members are aware of events regarding the clients. Before I would have worked at a pace of the teams expectations, literally running in and out doing tasks and leaving which is bad practice. Now i have the confidence to take visits back to team if I have not completed them as I realise the need to spend time with individuals so that a full assessment can be made and good quality care given.
My final competency is to be able to refer issues that fall outside of role to relevant people particularly in the context of results arising from patient assessment. I have improved developing my skills in this competency, whilst seeing a patient of mine for a wound assessment but realised this lady needed a pain assessment as well, because of the pain she was experiencing while I was applying a dressing to her leg. The pain that patients experience I feel, is often not well recognised by either a doctor or a health professional, so has a result it’s frequently under treated. Walker et al (2004)”suggests that pain-related fear is often more disabling than pain itself”. It’s vital we listen and pick up on any visual signs that a service user is in pain.
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