Transcript Document

Holistic Care and Assessment in Primary Care: The Healthcare Support Worker Role
The developing role of the Healthcare Support Worker (HCSW) is now
widely recognised and considered a fundamental part of the NHS
Modernisation Agenda (Wanless, 2003; Wag, 2005; WAG, 2010), in
order to increase flexibility and capacity and improve efficiency and
effectiveness by making best use of staff resources and skills (Spilsbury
et al, 2011). Assessing and caring for people holistically has now
become part of the appropriately trained HCSW’s role in general
practice. Appropriate delegation and understanding one’s own
accountability are critical to taking on this developing role. The Code of
Conduct for HCSW in Wales (WAG, 2011) and the All Wales Guidelines
for Delegation (WAG, 2010) clearly set out the standards that are to be
achieved in order that high quality, safe and effective care is delivered
by HCSWs.
The term ‘holistic’ refers to a philosophy of nursing
practice that considers all aspects of patient care,
considering the physical, emotional, social, economic
and spiritual needs of patient/clients/service users.
Within primary care all members of the nursing team will
make an holistic assessment. Gathering of information
and the formulation of judgements regarding a person’s
health, situation, needs and wishes which should guide
further action (DOH, 2000). It is the first stage in the
nursing process.
According to (WAG, 2010) failure to or inconsistent
approaches to delegation can have a negative
impact on the quality of care and the culture of the
work environment. Delegation is not new and is
practiced every day in a range of work
environments. Delegation is often undertaken as a
sub-conscious function. Its purpose is to ensure:
Service users receive timely and appropriate care.
Staff resources are utilised effectively, work is
shared fairly. HCSW feel valued and motivated,
which can achieve team success. It can also be
positive to make sure the HCSW is trained and
thinking and working more holistically for the best
care possible for the patient.
‘The gathering of information and the formulation of
judgments regarding a person's health, situation, needs
& wishes, which should guide further action.’ (DoH,
2000) The holistic nurse/HCSW is an instrument of
healing and a facilitator in the healing process. Holistic
nurses/HCSW honour each individual's subjective
experience about health, health beliefs, and values.
(RCN, 2010) state that all health care teams
include a range of registered professionals, health
care assistants (HCAs), assistant practitioners
(APs) and students. It is vital that each member of
the team is clear about their level of accountability
and that the registered staff are confident when
delegating tasks to their colleagues. That every
member of the team is trained appropriate before
providing holistic care to the patient.
It’s about collecting appropriate information or data
about a person, his/her carer and family. This could
be :- objective .. Involving blood pressure or
subjective.. based on a professional’s feelings, values
& beliefs.
To ‘undertake and document a comprehensive
systematic and accurate nursing assessment of
the physical, psychological, social and spiritual
needs of the patients, clients and communities.’
(DoH, 2000) The nurse/HCSW needs to be able
to provide a nursing diagnoses to identify the
patient’s needs. To ensure that the services
meet the needs of the patient and to avoid risks
to independence. To also develop goals and
outcomes and to develop care plans.
• All patients and clients have a right to
receive information about their condition.
• You must always respect a patient’s
autonomy.
• No-one has the right to give consent on
behalf of another competent adult.
• You must treat information about patient’s
and clients as confidential and use it only for
the purpose for which it was given.
• You should seek patient and client wishes
regarding the sharing of information with
their family and others. (NMC, 2008)
•
•
•
•
•
•
•
Family
Carers
Healthcare Assistants
Student Nurses
Qualified Nurses
Nurse Specialist's
Doctors
References
•
•
•
•
•
Observe
Touch
Listen
Smell
Use equipment to record vital signs:temperature, blood pressure, pulse,
respirations
• Assessment Tools
•
•
•
•
•
•
•
•
•
Breathing effort
Skin colour
Size of patient
Swelling
Distress
Rashes
General body language
Sputum
Urine faeces
•
•
•
•
•
Coherence
Communication ability
Noise of breathing
History of events
Ask questions in the correct way
(be diplomatic, specific, phrase
questions to provide yes or no
answers if the patient is unable
to speak clearly.
Department of Health (2000) Nurse, midwives and health visitors (training) Amendment
Rules approved order 2000. Stationary office. London NMC (2008) Code of Professional
Conduct:
standards
for
conduct
performance
and
ethics.
http://www.rcn.org.uk/__data/assets/pdf_file/0008/361907/Accountability_HCA_leaflet_A5_
final.pdf. Welsh Assembly Government (2005) Making the Connections Designed for Life:
Creating World Class Health and Social Care for Wales in the 21st Century. Cardiff, Welsh
Assembly Government. Wanless D (2003) Securing our Future Health: Taking a LongTerm View. The Final Report. London: Department of Health. Welsh Assembly Government
(2010) Setting the Direction: Primary and Community Strategic Delivery Programme.
Cardiff, Welsh Assembly Government. Welsh Assembly Government (2011) Code of
Conduct for Healthcare Support Workers in Wales. Cardiff, Welsh Assembly Government.
Spilsbury, K., Adamson, J., Atkin, K., Bartlett, C., Bloor, K., Borglin, G, Carr-Hill, R.,
McGaughan, D., McKenna, H., Stuttard, L, Wakefield, A (2011) Evaluation of the
Development and Impact of Assistant Paractitioners Supporting the Work of Ward-Based
Registered Nurses in Acute NHS (Hospital) Trusts in England. Final Report. NIHR Service
•
•
•
•
•
•
•
Setting the Direction (WAG, 2010) is a
community
based
strategy
that
advocates a paradigm shift from hospital
to community based care in Wales.
Holistic care and assessment involving
HCSW’s in the primary care setting, will
enhance the patient experience by
working in partnership with patients and
families to identify and address their
holistic health and social care needs,
whilst encouraging and supporting
independence (WAG, 2005).
Pulse
Temperature
Sweating
Clamminess
Pain
Sensation
Swelling
• Patient hygiene standards should be
assessed.
• Urinary tract infections maybe
evident
• A smell of ketones could indicate a
patient who is starved or a patient
with diabetic ketoacidosis
• Sputum
• Wounds
Student number 09050418