The assignment will discuss a critical incident from a nursing management perspective, being an admission assessment experienced during placement. It is not a care study. There will be an overview of the nurse-managers responsibilities during the admission assessment and attention drawn to local and government policy. Particular consideration is given to risk assessment, Essence of Care (DoH 2001) in respect of the Waterlow Pressure Damage Assessment (1985), pressure sores, nutritional screening and delegation. Other issues considered will be communication, partnership working, the therapeutic relationship, and the nurse as an agent of change. Findings will be supported by literature. Identifying factors have been changed to respect patient confidentiality.
Mary had no previous psychiatric history. She was eighty-four and lived in residential accommodation. She had two adult daughters who were unable to attend Mary's admission.
[...] As a manager in promoting evidence-based practice there is a need to monitor the incidence and prevalence of pressure sores and preventative measures taken by nursing staff alongside any risks specific to individual patient groups like older people and malnourished patients. To this end it is important to audit current practice of the risk assessment, and the degree of nursing knowledge in respect of this during admission assessments (Parker 1998). I believe that good management, competent nursing care and a “duty of quality” should ensure that these risks are identified upon admission during assessment; failure to do so is poor practice. [...]
[...] To manage patient care from a non-judgmental perspective the nurse-manager should keep an open mind and not label patients as mentally ill when the diagnosis is unknown and could be due to a physical reason (Abayomi, Hackett 2004). The doctor did not weigh Mary during the admission or detect that she was undernourished. Following this, I requested the ward manager purchase some NHS approved digital scales to encourage the doctor or nurse upon admission to weigh the patient. The current scales are a on' style and are locked away in a different area of the ward. [...]
[...] This meant that Mary was offered a choice of male of female key worker. Although this was good, policy also specified that she should have access to a female only lounge, which is not available. There is no provision for male only lounges either which is sexist towards male patients . There should also be female only toilet and bathroom. This was not available. The bathroom and toilet facilities were not defined. As part of my management placement I have arranged to discuss this matter with the Director of Nursing. [...]
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[...] A criticism of the Waterlow (1985) assessment scale is that it is used to identify risk, but does not provide evidence-based guidance as to the management of that risk (Parker 1998). The management of risk of potential pressure damage came down to the nurses' professional judgment. This can impact on patient care according to the competency level and knowledge of the nurse. However, part of the nurses' managerial responsibility is to be able to justify their actions, make professional judgments, ensure their knowledge and practice is based on evidence based research (McSherry, Haddock 1999). [...]
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