Importance of Communication and Assessment in Minor Injuries Care Management

This article discusses the importance of communication and assessment in the care management of minor injuries. It highlights the role of patient-centered communication and comprehensive assessment in providing quality care. The article presents a case study of a patient with a minor wrist injury and describes the steps taken by the nurse for assessment and diagnosis.

Running head: MINOR INJURIES REFLECTIVE ANALYSIS
MINOR INJURIES REFLECTIVE ANALYSIS
Name of the Student:
Name of the University:
Author note:

1MINOR INJURIES REFLECTIVE ANALYSIS
Table of Contents
Introduction/Background.........................................................................................2
Critical Narrative.....................................................................................................2
Conclusion..............................................................................................................8
References..............................................................................................................9
Appendix: Patient Assessment.............................................................................12

2MINOR INJURIES REFLECTIVE ANALYSIS
Introduction/Background
As a part of my present professional experiences, I am currently employed as a
Band 5 Agency Nurse in the Minor Injuries Unit (MIU) department of a healthcare
organization situated in the locality. Implementing therapeutic interpersonal
communication and comprehensive assessment along with acquisition of medical
history is an essential component in my daily professional duties since a lack of the
same can result in misunderstandings, avoidance of essential patient information,
misdiagnosis, incorrect intervention administration and hence, negative health
outcomes in the patient (Wiechula et al. 2016). I must hence, conduct a holistic
assessment and obtain the social, medical and personal history of the patient to identify
and incorporate the patient centered needs and preferences in the care plan of the
concerned patient. The following paper will hence comprise of a reflective analysis
highlighting the importance of communication and assessment for care management of
a patient admitted to the organization with a minor injuries complaint.
Critical Narrative
The concerned patient surrounding whom the reflective analysis will focus upon
is a 42 year old female, Anne Rutter. This patient was admitted recently to the MIU
department upon complaints of a minor injury. Upon arrival it was observed that the
patient was in a relative state of discomfort where she was seen to hold her left wrist
with caution. This clearly denotes that the minor injury presented by the patient is
associated with some form of pain in her left wrist. Indeed, as postulated by Kerr et al.

3MINOR INJURIES REFLECTIVE ANALYSIS
(2016), conducting observations by health professionals has been implied to be
beneficial in the acquisition of vital cues which can pave the way for further
comprehensive assessments as the patient-physician communication proceeds further.
Upon briefly observing the gestures actions of the patient, it is now required for
the nurse in question to communicate clearly with the patient and proceed to obtain vital
details regarding him or her. This will comprise of initially with the nurse introducing
himself or herself along with briefly obtaining the patient’s personal demographic details
and guide her through the possible clinical interventions which the nurse will be required
to conduct as the communication proceeds (Crawford, Roger and Candlin 2017).
According to Price (2017), such forms of interpersonal communication are vital to
establish a rapport with the patient and make him or her feel comfortable, secure and
eager to communicate his or her health problems with the nurse. Further, According to
Feo and Kitson (2016), adoption of a patient centered approach to communication by
the nurse, comprising of educating the patient on the possible clinical procedures and
interventions to be undertaken, not only provides scope for the patient to voice his or
her preferences but also instill perceptions of respect, dignity and quality care in the
patient. Such practices of patient centered, interpersonal communication also
demonstrate nursing compliance to the standards of practice postulated by the Nursing
and Midwifery Council (NMC), which include standards 1 and 2, instructing nurses to
treat patients in a dignified manner along with prioritization of their preferences and
needs (Nursing and Midwifery Council 2019).
The next procedure which the MIU nurse must adhere to is to conduct an
assessment, in which obtaining a comprehensive social and medical history of the

4MINOR INJURIES REFLECTIVE ANALYSIS
patient is of utmost importance. to adhere to the same, the nurse must adhere to the
NMC Code of Conduct with special emphasis on Standard 3 which necessitates nursing
assessment and prioritization of the social, physical and psychological needs of the
patient (Nursing and Midwifery Council 2019).
According to Pasupathy, Tavella and Beltrame (2015), considering the same, a
key assessment framework which can be utilized here is the ‘Six Honest Men’ tool
which requires nurses to inquire about patient demographics, needs and medical history
using 6 Ws, that is questions such as Who? What? Where? When? Why? and How?
Hence, following this simple assessment tool, we can uncover the following details of
the patient current admitted to the MIU: The patient is a 42 year old female know as
Anne Rutter, who has been admitted to the MIU upon complaints of pain in the left wrist.
Upon inquiring the patient, the nurse noted that she has recently encountered a fall on
an icy path near her house, two day back and landed on her left hand’s wrist specifically
with the objective of breaking the fall (FOOSH). This resulted in an immediate and
discomforting pain below the thumb, in the wrist of her left hand. While no immediate or
prominent swelling is observed, upon communicating, the patient admits that she is
perceiving pain which is increasing especially when she attempts to pick up or hold
small items. The patient also did not possess any significant patient history except for a
presenting with a current clinical condition of asthma. As per her present medical
details, she is currently consuming paracetamol for her pain and salbutamol for her
asthma and is otherwise free from any allergies. She communicated to the nurse on
living with her husband and her children, working as a teacher and on being a right
handed person.

5MINOR INJURIES REFLECTIVE ANALYSIS
According to Mitchell (2019), the advantage such a detailed and comprehensive
assessment and history taking is beneficial and essential since it will assist the nurse in
the accurately identifying the problem and diagnosing the health condition of the patient.
Further, as researched by Biddle et al. (2016), holistically taking the history of the
patient also paves the way for the nurse to identify the targeted assessments to be
conducted to present a nursing diagnosis. Indeed, the patient’s presentation of a
problem of FOOSH clearly now indicates the need to conduct a physical examination of
the patient’s arm and a hand and wrist assessment by the nurse. In criticism, according
to Hughes et al. (2015), however, it has been denoted that the such detailed
assessments comprising of processed of history taking can be time consuming and
nurses might as well address the diagnosis with mere consideration of the presenting
problem in the patient. However, considering my recent discussion posts and
professional experiences, there have been incidence when lack of acquiring a patient
history initially, resulted in absence of inclusion of essential details which could have
resulted in a misdiagnosis and medical error. Indeed, as researched by Louison et al.
(2018), conductance of a detailed patient history aids in identification of prevalent
medical conditions, allergies and intolerances in a patient resulting in improved
diagnosis, avoidance of possible medication errors and positive health outcomes.
Further, According to Richardson, Percy and Hughes (2015), considering the usage of
patient centered form of communication, some patients may be reluctant to share their
personal details or display aggressive behavior when asked with personal questions. To
combat the same, the nurse must empathize with the patient, listen with consideration
and use gentle persuasion to communicate the importance of an assessment.

6MINOR INJURIES REFLECTIVE ANALYSIS
Additionally, according to Beauvais, Andreychik and Henkel (2017), the nurse must also
adhere to skills of emotional intelligence and demonstrate awareness of personal as
well as patient’s emotions for improved therapeutic communication, nurse-patient
rapport and positive patient health outcomes.
Hence, to summarize, I must adhere to the above patient centered approaches
while conducting as assessment in my professional practice. In addition to the above
pre-requisite information, it is observed that the nurse proceeds with various steps of
physical examination coupled with hand and wrist assessment. According to Lewis and
Smith (2015), FOOSH is often associated with patients acquiring injuries from a highly
forceful and impactful fall which can result in a fracture or severe injury to the upper
arm, considering the exertion applied from the ulna to the distal humerus. Hence, the
nurse must carefully palpate and examine the movement of the upper arm and assess
for pain which in this case, and absence of the same and normal range of movement
were observed (Marco, Humphries and Mozeleski 2017). It is observed sequentially that
the nurse undertakes an examination of the wrist of the pain, for presence of fractures in
the ulna and the distal radius. It has been evidenced by Corsino and Sieg (2019), that
FOOSH is often associated with distal radius and ulna fractures which are indicated by
presence of deformity, swelling and are often common in the elderly due to detrimental
musculoskeletal effects of ageing. The patient presented no such signs of fractures in
this area except for presence of minor swelling in the anatomical snuffbox (ASB). The
presence of swelling and tenderness in the ASB however, after an incidence of FOOSH,
is indicative of the possibility of a fracture in the scaphoid (Makhni et al. 2017). In
criticism however, as per the admission details, the concerned patient however

7MINOR INJURIES REFLECTIVE ANALYSIS
presented the complaint to the MIU, after almost 2 days of the incidence. According to
Kim and Yanuck (2018), this may indicate that the pain and discomfort of the patient
relatively lacks severity and hence, rules out the possibility of a fracture in the scaphoid.
However, we must consider a comprehensive history of the patient to prevent any form
of misdiagnosis and errors in intervention administration. Taking insights from the same,
it must be noted that the patient is encountering pain while picking up small objects,
hence, indicating possible scaphoid fracture. Further, as researched by Buijze and
Jupiter (2017), merely a physical examination is inadequate in conforming the diagnosis
of a fracture. There is hence a need to undertake comprehensive assessment in the
form radiological procedures such as X ray, which if is indicative of fracture, will require
the nurse to adhere standard 13 and refer the patient to an occupational therapy to
provide multidisciplinary care (Nursing and Midwifery Code 2019). In addition to the
above, it is also observed that the sequential hand and wrist assessment conducted by
the nurse, also includes instructing the brief movements (flexion, adduction, abduction,
extension, opposition) of the thumb and fingers where the range of movement and
presence of any stiffness and pain is observed. This is performed considering that the
FOOSH has also been associated with injuries and fractures to the carpal bones in the
wrist, of which, the scaphoid poses the greatest risk mentioned above (Turan et al.
2018).
Nursing interventions must also consider, along with the physiological conditions,
the social, occupational and personal needs of the patient, as per NMC standard 3
(Nursing and Midwifery Council 2019). In the given case study, despite encountering an
injury in the non-dominant hand, administering a cast to address any fractures in the

8MINOR INJURIES REFLECTIVE ANALYSIS
scaphoid would hinder her work as a teacher along with taking care of her household
and performing activities of daily living. Hence, According to Hang et al. (2017). using
patient centered and family centered approaches, the nurse can communicate with the
patient and her family on administration of thumb spica cast for pain reduction as per
local clinical recommendations and guidelines. While such as cast may still hinder daily
activities, such interventions may prevent aggravation of symptoms in case of a missed
diagnosis of a fracture (Dixon et al. 2018). Additionally, as per NMC standard 9 and
provide professional feedback and education to the nurse as well her family on the need
to take precautions while lifting objects, ensure provision of support and assistance at
home and engage in following up with the nurse for nursing evaluation of progress or
deterioration (Nursing and Midwifery Council 2019).
Conclusion
In conclusion, the given paper demonstrates a reflective analysis of the key
sequential and evidence based procedures which the nurse must keep in mind for the
purpose of ensuring achievement of positive health outcomes, health and optimum
wellbeing in a patient who has been admitted with the complaint of a minor injury. Thus,
this paper proved to be a vital education resource which has improve my existing
knowledge and insight on the professional standards I must adhere to when I will be
required to screen and communicate with a patient in real life occupational settings.
Indeed it has been postulated that practices of reflection and mindfulness after patient
care management is an effective strategy with which nurses can identify their personal
strengths, professional or clinical shortcomings in the patient care plan and incorporate

9MINOR INJURIES REFLECTIVE ANALYSIS
possible improvements for the future. Additional the reflective analysis in this paper also
demonstrates the importance of communication, patient centered interaction and patient
participation which I must address to optimally conduct my professional practices as a
nurse working in the MIU unit. Nursing communication strategies of patient participation
indeed paves the way for improved understanding by nurses on the needs of the patient
which must be empathized in conducting an assessment and care plan. In criticism,
patient participation is often difficult since patients may feel distrustful and reluctant to
communicate. To counter the same, nurses must adhere to NMC codes of privacy,
obtain consent and empathetically communicate with the patient to regain his or her
trust.

10MINOR INJURIES REFLECTIVE ANALYSIS
References
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and empathy in compassionate nursing care. Mindfulness & Compassion, 2(2), pp.92-
100.
Biddle, L., Paramasivan, S., Harris, S., Campbell, R., Brennan, J. and Hollingworth, W.,
2016. Patients' and clinicians' experiences of holistic needs assessment using a cancer
distress thermometer and problem list: A qualitative study. European Journal of
Oncology Nursing, 23, pp.59-65.
Buijze, G. and Jupiter, J.B., 2017. Scaphoid Fractures: Evidence-based Management.
Elsevier Health Sciences.
Corsino, C.B. and Sieg, R.N., 2019. Distal Radius Fractures. In StatPearls [Internet].
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Mauldin, F.W., 2018, October. Detection of Distal Forearm Fractures Using Bone-
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11MINOR INJURIES REFLECTIVE ANALYSIS
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Injuries and Fractures in Children: Is Cast Immobilization Always Necessary?. Clinical
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12MINOR INJURIES REFLECTIVE ANALYSIS
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Appendix: Patient Assessment
Date: 29th June, 2019
Name: Anne Rutter
Age: 42 years old
Gender: Female
Past Medical History: Mild Asthma
Social history: Married and lives with two children (8 and 6 years old) and husband, works as a
teacher
Drug History: Consuming paracetamol for pain, takes salbutamol inhaler for asthma, no known
regular medications or allergies due to drugs
History of presenting complaint: FOOSH: Slipped and fell on an icy path near home, landed
on left hand wrist for breaking the fall.
Examination and findings: Physical examination and hand and wrist assessment did not
indicate any stiffness or fracture in the forearm .
Differential Diagnosis: Swelling and tenderness in the ASB may indicate fracture in the
scaphoid.
Investigations and further tests: X ray in the scaphoid

15MINOR INJURIES REFLECTIVE ANALYSIS
Working Diagnosis: Scaphoid fracture
Brief management issues and referral: Administration of thumb spica fracture and referral to
occupational therapist.