Communication is sending and recieving information, to establish and understanding.

The four main methods of communication are: written, non verbal, verbal and visual.

Verbal communication can be understood as; language both written and spoken. For example, talking face to face, public speaking, preaching, monologue.

Non verbal communication can be understood as; the exchange of information without the use of speech. examples are: body language, smiling, gestures and posture, eye contact, sign language.

Written communication can be understood as; exchange of information using words and numbers. Examples are: sending emails, writing letters, sending text messages, report writing.

Visual communication can be understood as; the use of visual elements to convey ideas; signs, drawing, graphic desgins, illustration, industrial desgins.

Effective communication requires individuals to be clear and concise in communicating. This includes exchanging information with clarity, empathy and understanding.

The four main ways of communication are verbal, written, non-verbal and visual.

It is important to make the patient feel comfortable, accepted, to be responsive, and to show empathy. This includes being warm and approachable - as often patients can feel discriminated against or stigmatised.

It is important to be a good listener, to gather information from the patient. Also to be non-judgemental. It is also good to provide reassurance.

It is also important to have good body language.

It is important to give the patient time, and not to rush them.

It is also good to provide an interpreter when necessary.

It is good to have detailed documentation including everything that the patient is telling us.

It is vital to obtain consent.

When communicating with the patient you need to ask them open questions in order to get more information.

4 ways of communicating:

Verbal, written, non-verbal, visual

1. Prioritising of care is important to prevent patients deteroriating, and situation worsening.

2. the ability of nurses prioritising patient care is paramount because, it is larger dertermined success or failure in delivering quality health care.

3. nurses with better prioritising skills would be better equipped to make strategic decisions, show excellent judgement, display strong time management skills.

Skills needed to prioritise care are:

good listening skills, time management, team work.

Assessment tools needed to prioritise care are:

1. assessing patients basic needs to determine appropriate treatment plan. One method is assessing NEWS2 early warning signs; pulse, breathing rate, temperature, oxygen saturation.

2. general observation is also tool of assessment. for example monitoring blood sugar levels.

3. interview is also an assessment tool as this provides nurses with the opportunity to assess patient history, current situation to determine treatment plan.

4. Activity of daily living scale

assessment can be understood as evaluating and determining most critical health care needs, based on the patient condition, the severvity and urgency. Also helps to identify, engage the extent of specific conditions and provide fair approach in response.

Prioritisation of care is important because it reflects on our duty of care and prevents an ill outcome. Also systematically helps you analyse the needs of the patient and saves times.

The skills needed; good communication, proactiveness, analytical skills, time management, good team player, knowing how to risk assess and competence.

Assessments used to prioritise care; observation (NEW2), 1-1, risk assessments, care plan, SMART, Waterlow assessment and Triage assessment.

Effective communication is the process of exchanging ideas thoughts, opinions, knowledge and data so that the message is received and understood with clarity and purpose.

For ex.

to minimise misunderstanding, and to develop strong relationships with patients and staff.

Types of communication

verbal, non-verbal, written, visual.

Taking into consideration people's interests and care needs, including aspirations and goals. This includes promoting recovery.

Listen attentively - to try and figure out the most important things to prioritise. Pay attention to what is being said both verbally and non-verbally.

Consider risk factors - have background information about the patient and what they are currently experiencing in terms of their mental health, to know what to prioritise. e.g. risk of self harm/suicidal ideation. Prioritise to attempt to reduce the risk.

Involve the patient in the decision making, and also their family/guardian. (With the consent of the patient)

Skills we need to prioritise care:

• Good communication skills: listening, involving an approved translator?

• Good writing skills and documentation

• Ability to create a good care plan that includes the identified priorities e.g. cultural, religious, dietary needs

• Have knowledge and a good understanding about diversity, and what is suitable. To always seek consent

Assessment tools used to aid prioritisation:

• SBAR

• Observation chart/NEWS

• CMA

What is prioritisation of care?

-This is putting the interest of the patient using or needing services first

Why is prioritisation of care important?

-If you miss caring for immediate priorities the patient's health may worsen and become more difficult to manage/

What skills are needed to prioritise care?

-Good communication skills, effective teamwork, empathy, critical thinking and time management.

Can you name any assessment tools used to aid prioritisation?

-Vital signs, Addenbrooke's cognitive examination (ACE), two-stage capacity test.

B - Breathing

C - Circulation

D - Disability

E - Exposure

F - Fluids

G - Glucose

For patient assessment it is good to:

• Rule out physical conditions - do physical health assessment, e.g. vitals, ABCDE

• Find priority needs

• Consider patient triggers

• Handover well through SBAR

• Look at the person holistically - consider everything, including social circumstances

Vital signs:

• Oxygen levels

• Pulse

• Temperature

• Respiration rate

• Blood pressure

• Blood sugar levels

• Consciousness?

• Urine output

• Blood test

Recommendation for scenario 1:

• Call the ambulance

• Explain your concerns/the location/description of the woman

• Someone from the hospital to inform social services/homeless team

Scenario 2:

• The lady needs an assessment to figure out her mental health and social needs (e.g. where is she living, who is she living with) - mental state examination

• Capacity assessment - do social services need to be contacted? Safeguarding?

• Referral to perinatal team?

Airway

Breathing

Circulation

Disability

Exposure

An approach to the immediate assessment and treatment of critically ill or injured patients.

Frankie Case study

Patient walked in with abdominal pain, appeared unkempt, presented unwell, has history of homelessness. Frankie was assessed and reviewed by NIC. Recommendation was given and option of care was provided by NIC.

Introductions and purpose of assessment made to Frankie, Consent to treatment obtained.

Frankie's vitals were conducted.

Frankie was offered hot tea and snacks.

Frankies abdominal pain was assessed, and a reccomendation for medication was suggested to the NIC.

Frankie's mental state (mse) was assessed and documented.

Frankie was offered to have a bath, however she refused, she was then re-assured taking a bath would help her to feel better, which she eventually agreed to with the support of female nurse.

Frankie agreed to have a full nursing assesment later when she rested for a few hours.

What vital signs are conducted and what are the normal ranges?

Respiration rate: 12-16 breaths per minute

Pulse rate: 60-100

Blood pressure: 120/ 80

Saturation Levels : 95-100%. (SpO2). Sats for COPD would be between 88-92.

Body temperature: 36.5- 37.5 degree celisus

Conciousness: Alert, confused

Case study 2:

Contact 999

Introduce yourself and ask for the patients name

Ask if patient has taken any substances

Check the environment for hazards

Check patient airway as respiratory rate is low

Check patients pulse (manually)

Keep patient warm

Place patient in recovery position

Keep patient calm

A physical assessments includes physically examining the patient and helps us to critically analyse the level of illness a patient is at. In Frankie's case, we would begin by conducting the ABCDE assessment before immediately contacting emergency services.

The observations of body temperature, pulse rate, respiration rate and blood pressure, are all considered vital signs. This is because it indicates whether there body is functioning well and whether there is anything of concern to monitor.

normal ranges

blood pressure-120/80

respiration rate-12-18 breath per minute

pulse rate-60-100 beats per minute

temperature - 36-37.2c

What does A-E assessment stand for?

-Airway, Breathing, Circulation, Disability and Exposure.

What does physical assessment entail?

-It entails doing

1. AVPU (awake, voice, pain and unresponsive)

2. Blood glucose level

3. NEWs score

   
   

What would you consider about Frankie?

First scenario

1. Put the patient in a recovery position

2. call for help, ambulance

3. Check airway

4. listen to breathing

Katia scenario

1. Mental state examination

What observations are part of vital signs?

1. blood pressure

2. sats

3. temperature

4. pulse

5. heart rate

6. Blood monitoring

   
   

• confirmation of identity

• concise writing

• documenting as frequently as needed e.g. hourly, twice a day / when a major event happens

• done immediately (or as soon as you can) - as close to the time the care was given

• writing exactly what you see

• factual, not opinion - accurate and relevant to the individual

• relevant to the assessment carried out

• no jargon

• accurate time and dates

• when, where and why

• care plans, risk assessments, medication administration

• physical notes - e.g. weight, height, etc.

• avoid duplication of notes / do not copy and paste

• ensure you have the right details

• proofreading of written notes

1. Clearly written and to the point.

2. Confirm we are writing notes to the correct patient (e.g. right D.O.B)

3. Avoid late entries

4. Write down information accurately and in real time

5. Date, time and signature

6. Well detailed and contain factual information.

7. Should have agreed actions, plans and recommendations.

8. Prioritise legibility (others should be able to clearly understand the information)

9. Use the right tools e.g. nursing documents can be used for legal proceedings, for that reason use only black ink and never erase any information.

10. Follow policy

11. document physician consultations e.g. patient care including names, times, responses and any resulting actions which is critical in a case needed in an emergency.

12. No duplications

Be clear, concise and complete and it entails personal data.

personal data: patient names, DOB, address, Sex, Next of kin, email address, contact number. patient history, patient allergies, time and date clearly,

The record should include: assessment, planning and evaluation of care

Vital signs obtained; NEWS2 0. Skin check done, all pressure areas intact. Assisted with personal hygiene; bed bath given.

Refer to Doctor for Analgesia and scan for abdomen.

Follow up for review.

Carry out observations to ensure she has her fluids. Make sure the pt is sitting upright to aid with heart rate.

Gemma is screened to check if she COPD or Asthma. Once that is established Oxygen/Nebuliser is administered as prescribed by the Doctor. Also will ensure Gemma is sat upright and closely monitored. Will carry out an ECG and request a chest x-ray. Gemma will be kept on a cardiac monitor. Blood test should be done and VBG (Venus Blood Gas).

Diagnosis ; Bipolar disorder (5 episodes, 1st episode at 22 years old)

Trigger ; Smoking cannabis which induced psychosis, rapid thoughts

Symptoms ; Loss of appetite, insomnia, hallucinations and delusions, confusion,

Intervention; Sectioned, received medication, receives family support, supportive nurses

Clinical assessment

-Get the equipment ready

-First introduce yourself

-confirm patient details

-tell the patient what you will be doing and gain consent

- do the vital signs

- Inform the patient i am here to support with their personal care.

decision

Handover

-Frankie is a 45-year-old woman, who is reported HOMELESS with ABDOMINAL PAIN. she is been HOMELESS for the past 9Months due to her being SEPARATED from her partner, lost her JOB. She appears UNKEMPT and in PAIN. VITAL SIGNS has been done, scored (5) which means hourly check and documented. she was offered tea and a sandwich which she enjoyed

Recommendation

FRANKIE refuses personal care, VITAL SIGNS should be done hourly due to the news score of 5. The doctor has been informed about the patient.

Gemma has a News score of 8 so nurse in charge needs to escalate to senior doctor. Gemma should be observed half hourly minimum.

Triggers:

• Cannabis

• Breakdown of relationship

Symptoms

• Sleepless nights

• Loss of appetite

• Pressured speech

Michalea A-E Assessment

Respiration is 22bpm - 2

02 Saturation 96% -2

pulse rate 110bpm -1

B/P 130/85 -0

blood Glucose 3mmol

Temperature 36.2 - 0

Oxygen - AIR - 0

Cons - ALERT -0

NEWS TOTAL = 5

GEMMA A-E Assessment

Respiration is 35bpm - 3

02 Saturation 89% -3

pulse rate 120bpm -2

B/P 110/65 -1

blood Glucose 3mmol

Temperature 36.2 - 0

Oxygen - AIR - 0

Cons - ALERT -0

NEWS TOTAL = 9