[Solved] a service user with cerebral palsy and dysphasia

This care study is about a service user with Cerebral Palsy and Dysphasia. This assignment will give a brief description of her background history, her condition and care needs. In order to maintain the confidentiality of the service user, I will refer to her as Daisy Chain and any personal information will be changed accordingly and not be used in conjunction with anything else other than this study. I obtained consent from the service user, her family and the adult day centre where she attends.

Together we all arrived and agreed with the name Daisy Chain to use in place of her real name, as once again to maintain her confidentiality. (Anderson, 2010) Anderson (2010, p. 53) wrote that “Consent covers more than simply gaining permission to carry out a specific procedure, typically a surgical intervention. It also involves willingness on the patient’s part to cooperate in what is proposed and in this context the level of disclosure and the way information is provided may differ”.

This care study will use two of the Chapelhow et al (2005) enablers to help me reflect on and discuss care. These are communication and assessment. The links between these two enablers together with their related documentation will also be discussed. Daisy is 31 years old and has a condition called cerebral palsy as well as Dysphasia. The extent of her condition has left her profoundly disabled and she requires total 24 hour care. Daisy is doubling incontinent and has a catheter and stoma in place. Daisy does not communicate verbally and also has limited non-verbal communication skills.

She can understand what you are saying to her, but can only answer you back by giving facial expressions, for example by smiling, nodding and shaking her head. She can move her arms and can hold small objects/items, such things as a book, pencil etc. Daisy cannot tolerate drinking or eating and is therefore fed via a peg feed, which is inserted through the naval cavity and goes direct into her stomach. Daisy lives at home with her mum and dad and her two siblings. She is the middle child and the only girl.

Daisy is well taken care of; her family always makes sure that she is always clean, tidy and happy. Daisy can only be moved via a hoist transfer. Daisy attends an adult day centre, where she can mix with other service users her own age and with similar conditions and issues. Daisy has been attending the day centre for three days a week for the past 10 years. Here she can engage with the daily activities that are available for her at the centre. Some of the activities that she gets involved in are country dancing in wheelchairs, singing and signing, and story time.

She also likes to get involved with baking and loves going out for walks to the local park, shops and library. Whilst she has been at the centre and at home, she has become a very sociable, loving person, who is always laughing, smiling and enjoying everything at the centre that is available to her. Before Daisy began attending the centre, she was a very sad and withdrawn person at home. Her family could not understand why. They had tried everything within their power to try and make her happier, but no matter how hard they tried; she would still be the same.

Over the years the centre has totally changed Daisy from a sad and withdrawn person, to a much happier one. When communicating with Daisy it is important that you understand the methods of what and how she communicates back to someone. Communication is about making contact with other people and also being understood. It involves people sending and receiving messages, and that we are always sending and receiving messages continuously. It is a two-way process that requires speaking and listening to each other, which must occur for it to be effective communication. Endcott, R. , Jeven, P. and Cooper, S. , 2011) (French, 2002) There are many forms of communication; these can be used in different ways by nurses/care workers, during the day/night. The frames/skills mostly used are verbal, which involves talking and listening; non-verbal, which involves touch, eye contact and facial expressions. This is what Daisy mainly uses to communicate with you. Most nurses/carers manly use both of these forms communication when they give/receive information about care that has been provided for an individual.

Nurses/carers need to provide emotional support to the individual or a family member, when carrying out an assessment of the individual’s care needs. (French, 2002) (Kraszewski, S. and McEwen, A. , 2010) (Waters, A. and Whyte, A. , 2012) Nurses/carers need to use a range of verbal skills when trying to assess or find out the individual’s problem/needs, to respond to questions and to deal with problems/complaints, or to provide support to others. Many people have suggested the fact that listening is much harder than speaking and that there is more to this skill than just waiting for the other person to stop talking.

Whist most other people use verbal communication; some individuals such as Daisy can only use non-verbal communication. She uses many forms of non-verbal communication, these are: facial expressions, by the movements of the face that expresses her feelings, for example she smiles/frowns; touch or contact, by where you are physically touching/holding her; Gestures, where you are using deliberate movements of the hand to express meaning; eye contact, by where you are looking at her directly into the eye. (French, 2002) (Endcott, R. , Jeven, P. and Cooper, S. , 2011) (Kraszewski, S. and McEwen, A. 2010) There are some factors associated with barriers of communication. These can have an effect on an individual’s ability to communicate effectively, by preventing or interfering with the person’s ability to send/receive or even understand a message. Such is the case with Daisy. She has Cerebral Palsy and Dysphasia, which both have a severe impact on her ability to communicate verbally and to interpret other people’s non-verbal communication. So a nurse/carer should therefore be alert to the additional communication needs for people like Daisy, with sensory impairments and disabilities.

This means that simply things like signs cannot be seen, leaflets cannot be read and conversation cannot be heard correctly. So it is essential that you understand Daisy’s communication needs to be able to communicate with her effectively. (Kraszewski, S. and McEwen, A. , 2010) (Endcott, R. , Jeven, P. and Cooper, S. , 2011) (French, 2002) One of the ways in which you can break Daisy’s communication barriers, is that sometimes it may be necessary for her, as a person with limited non-verbal communication skills, to have an advocate who can speak and act on her behalf as and when required.

An advocate is someone who will listen to you and can speak up for you so that your views and concerns are heard, and that your rights are met and any problems resolved. Casey and Wallis (2011, p. 35) said that “One of the most basic goals for nursing staff is that their patients and clients and those who care for them experience effective communication. The national bench mark for communication required that “all communication needs are assessed and appropriate methods are used to enable patients and carers to communicate effectively.

Information that is accessible, acceptable and accurate, and that meets patients and client’s needs, should be shared actively and consistently. ” The Scottish Public Services Ombudsman (2010) reported that “communication and confidentiality were once again near the top of the list of complaints about the NHS. ” (Casey, A. and Wallis, A. , 2011) And in England, the ombudsman reported that “poor explanations or an incomplete response were the most common reasons for dissatisfaction with complaint handling. ” (Casey, A. nd Wallis, A. , 2011, p. 35) Assessment is known for being the first step in the process of a person’s personalised nursing care. It provides certain important information that will enable the development of a care/action plan, which would benefit the individual’s personal health status. The assessment documentation forms an essential part of the patient care that should be viewed as a continuous process. It is essential for a nurse to be careful when doing assessments on a patient’s psychological care needs.

This is because every person/patient who is being assessed for their coping style needs for support should be discussed during certain stages of their illness. Everyone’s needs are diverse and therefore the individual’s discussion is necessary for any professional to negotiate and understand the type of care and treatment that is needed for that individual. (Endcott, R. , Jeven, P. and Cooper, S. , 2011) (Kraszewski, S. and McEwen, A. , 2010) Nursing models are sometimes used as a guide in the overall approach to care within a certain environment.

It therefore provides the focus for any clinical judgements and decisions that result from this process of assessment. It has been argued that “whist nursing models have not been widely implemented in clinical practice; nurses do use them as a way to consider the process of nursing. (Wimpenny 2011) During any patient assessment, nurses engage in a series of cognitive, behavioural and practical steps but do not always recognize them as discrete decision making entities. (Ford and McCormack 1999)” (Dougherty, L. and Lister, S. , 2011, p. 8) There are many different formats to collecting information about a person. They consist of both subjective and objective data (qualitative and quantitative data). These can be obtained in a number of different sources; for example repeated information that is offered directly by the patient/family members, or any other health care workers. The information could give an insight to their normal day to day routine and any present concerns. Observed information can be gathered through observing the patient/client; for example the condition of their skin, their ability to walk/move.

One can also get some information about the way that they interact/communicate with others. Clinical information may use vital signs, medical diagnosis, blood, x-ray/scan results and any other results from any assessments/treatments by other healthcare workers. (Endcott, R. , Jeven, P. and Cooper, S. , 2011) (Barret, D. , Wilson, B. , Woodlands, A. , 2012) (Naidoo, J. and Wills, J. , 2000) (Dougherty, L. and Lister, S. , 2011) When looking at nursing models there is none that actually fits Daisy for an accurate assessment.

This is because of her communication issues and disability issues. The only way that an accurate assessment can be done for Daisy is through the focused and on-going assessments, which are assessments that look at a specific condition or problem and by identifying any risks. This is done through observation, and by watching how she communicates to others, and by seeing how she interacts with the facilities available to her at the centre. Once she has been observed in her abilities and findings to what she likes and dislikes, it is then an action/care plan can be put in place for her.

Daisy’s action/care plan is on-going and continuous and needs to be monitored and updated as and when required. (Dougherty, L. and Lister, S. , 2011) (Barret, D. , Wilson, B. , Woodlands, A. , 2012) There are some studies of nursing assessments but not many, and they indicate that some discrepancies between nurses’ perceptions and those of their patients are common. Which means that communication is therefore the key, as Suhonen et al (2000) suggest “there are two actors in individual care, the patient and the nurse”. (Dougherty, L. nd Lister, S. , 2011, p. 29) Within The Royal Marsden book of Clinical Nursing Procedures, it is written that gaining an insight into the patients’ preferences and individualised need is made easier by meaningful interaction, which depends on the patients’ willingness and capability to participate in the process of the nurses’ interviewing skills. Some patients may find it difficult in discussing some of their problems. Once both the patient and the nurse have gained each other’s trust, and any potential problems identified.

It is then that the patient will know that the nurse’s assessment is actually looking at their health and well-being. (Dougherty, L. and Lister, S. , 2011) When one communicates with someone or undertakes an assessment of any kind, it is important that one documents everything that has been said and done, either by hand written records or on electronic records. It is recommended that both should be done, because one will always need a back-up if something was to go wrong with either.

The reason why one has to record things is so that one will always have evidence that something has been done. According to the NMC code to keeping clear and accurate records, “You must keep clear and accurate records of the discussion you have, the assessments you make, the treatment and medicines you give and how effective these have been. You must complete records as soon as possible after and event has occurred. You must not tamper with original records in any way. You must ensure any entries you make in someone’s paper records are clearly and legibly signed, dated and timed.

You must ensure any entries you make in someone’s electronic records are clearly attributable to you. You must ensure all record are kept confidentially and securely”. (Dougherty, L. and Lister, S. , 2011, p. 1025) (Casey, A. and Wallis, A. , 2011) All the evidence in this essay shows that communication is important when it comes to do anything at all within life. Without effective communication and communication skills, a health practitioner will not be able to communicate with a patient/client effectively to gain a correct assessment.

Whether it is a risk assessment or making decisions, if they do not know how to communicate effectively they will therefore not be able to get a correct/accurate assessment of the individual. This will then lead to the documents not being recorded accurately, and it therefore can lead to serious problems. Communication skills are important as health care professionals need to focus on the quality of the client’s life and effective communication can improve the quality of life. Also communicating with relatives and with other professionals in important because one needs to make sure that they understand what one is trying to tell/say to them.

It is a known fact that effective communication is important within a health care setting because, people who work within the health care sector need to be able to communicate well so that they can develop positive relationships and share information with others. Communication is the key for good interpersonal skills within the health sector and is essential for care work. For this to happen, anyone working within the health sector needs to be good at listening to others as well as being able to speak in a way that others can understand you.

The reason for this is that one has to listen to the patients in hospitals, the service users who use the health/social services, relatives and any other professionals, like doctors, social workers etc. , and anyone else who helps with the care of people. (Rasheed, E. , Irvine,J. , Hetherington, A. and Wyatt, L. , 2010) (Casey, A. and Wallis, A. , 2011) (Dougherty, L. and Lister, S. , 2011) (French, 2002)

REFERENCES USED: Accleton, P. and Chalmers, H. , 2000. Nursing Models and Nursing Practice. Hampshre: Palgrave. Anderson, E. S. , Ford, J. , Thorpe, L. , 2011.

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Essex: Pearsons Education Limited. Blair, J. , 2011. Care adjustments for people with learning disabilites in hospitals. [Online] Available at: http://www. nursing,management. co. uk [Accessed 16th August 2012]. Casey, A. and Wallis, A. , 2011. Effective Communication: Principle of Nursing Practice E. Nursing Standard, 13 April, 25(32), pp. 35-37. Cutcliffe, J. , McKenna, H. and Hyrkas, K. , 2010. Nursing Models Application to practice. London: Quary Books Division, M A Healthcare Ltd. Dougherty, L. and Lister, S. , 2011. The Royal Marsden Hospital Manual of Clinical Nursing Procedures, Student Edition. ighth ed. Oxford: Blackwell Publishing. Elckersley, J. , 2009. Coping When Your Child Has Cerebral Palsy. London: Sheldon Press. Endcott, R. , Jeven, P. and Cooper, S. , 2011. Clinical Nursing Skill: Core and Advanced. In: Oxford Handbooks In Nursing. Oxford: Oxford University Press, pp. 66-83. French, A. , 2002. Interpersonal Skills. London: The Industrial Society. Health, D. o. , 2010. Essence of Care 2010: Benchmarks for Communication. [Online] Available at: http://bit. ly/hloYIx [Accessed 22nd March 2011]. Kraszewski, S. and McEwen, A. , 2010. Communication skills for adult nurses.

Maidenhead: Open University Press. Naidoo, J. and Wills, J. , 2000. Health Promotion, Foundations for Practice. 2nd ed. London: Bailliere Tindall. Rasheed, E. , Irvine,J. , Hetherington, A. and Wyatt, L. , 2010. Health and Social Care. London: Hodder Education. Rull, D. G. , 2009. Dysarthria and Dysphasia. [Online] Available at: http://www. patient. co. uk/doctor/Dysarthria-and-Dysphasia. htm [Accessed 31st July 2012]. Waters, A. and Whyte, A. , 2012. Nurses have a duty to be kind, friendly and polite. Nursing Standard, 8th February, 26(23), pp. 16-18. | |

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