Nursing Assessment Critique: Communication and Assessment of an Older Patient

This report critiques the assessment of an older patient, Max, by a Registered Nurse from Aged Service Emergency Team (ASET). It highlights the communication barriers faced by aged people and suggests person-centred communication strategies. The report also discusses the process of assessment, strength-based assessment, and self-help strategies for Max's health concerns.

Nursing Assessment Critique

Table of Contents
Introduction.................................................................................................................................................3
Person Centred Communication with an Older Person................................................................................3
The Process of Assessment..........................................................................................................................4
Strength Based Assessment.........................................................................................................................5
Conclusion...................................................................................................................................................6
References...................................................................................................................................................7
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Introduction
Aged-based care is of much importance and the nurses handling aged people must be well-
equipped with needful skills and knowledge. This report will be analysing an assessment
regarding the condition of Max, an older patient who just went through crucial knee surgery,
conducted by Registered Nurse from Aged Service Emergency Team (ASET). It will reflect the
communication problems caused to the older patients due to age related factors. It will show that
aged people are more vulnerable to health problems and will also state the underlying reasons.
Needful person centred communication strategies would be suggested after identification of
barriers of effective communication of the patient through thorough analysis. The report will also
focus on the assessment related factors which could have been addressed more briefly by the
nurse. Self-help strategies will also be provided to him on the basis of his health concerns.
Person Centred Communication with an Older Person
Person-centred communication is a tool by using which the care givers or nurses enable a person
to identify their positive and negative health aspects and suggest how to use their existing
potential to reduce the negative aspects and strengthen the positive ones (Philp et al. 2017). This
not only helps the individual to assess their present health condition, but also renders them
needful ideas to overcome those. Person centred communication is a commonly used phenomena
is the context of aged care. With age, the bodily functions start to lose its efficacy due to
numerous health related factors. Minor to major issues start to create hindrances for the aged
people, affecting their communication (Ewing, Austin, Diffin & Grande, 2015). In the given
assessment, Max is also experiencing certain health issues which are impacting his effectiveness
of communication process. Hearing impairment among aged people is a common issue which is
caused when the hair cells or the nerves in cochlea are affected (Yang, Schrepfer & Schacht,
2015). As the hair cells do not grow again, it becomes a permanent damage. As a result, the
hearing of the host is impacted. Hearing deficit stops a person from receiving information
properly, thereby impacting the effective communication. On being asked, Max states to Robyn
that he does have some hearing issues. Robyn was talking in a clear audible way and she also
came to know that Max was not using his hearing aid. She did not further inquire about the
reasons behind his unwillingness to wear those.
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Vision impairment is also a crucial problem from which most of the aged people are suffering.
Due to Age related Macular Degeneration (AMD), Cataract, Diabetic Retinopathy, and
Glaucoma, numerous aged people are suffering from eye-sight related problems (He et al. 2014).
Robyn spotted Max’s glasses and confronted him about his eye-sight along with detailed
questions regarding when he needs to wear those. Robyn comes to know that Max got his eyes
checked up a month ago which she appreciates and encourages him to do it more often. Social
isolation is another issue faced by aged people as they slowly withdraw themselves from social
gatherings (Valtorta, Kanaan, Gilbody & Hanratty, 2016). This affects their ability to
communicate with people; thereby creating a barrier in the way of effective communication.
According to Disassociation theory of aging, aged people are likely to become socially isolated
with time (Shanas et al. 2017). Max also claimed to be socially inactive. Robyn did not try to
investigate further which is regarded as a major drawback of the assessment. She could have
asked more questions to know if money problem or harassment is associated with this social
withdrawal of Max.
The Process of Assessment
During the assessment, Max tells Robyn that at times he becomes heavily depressed. Depression
is a critical problem, especially for aged people who are not socially active. He also adds that he
is managing this problem as of now. Robyn also did not initiate critical analysis to understand
the root of the depression. She could have taken some extra effort to understand the overall issue
of Max which was causing the depression. Geriatric Depression Scale (GDS) could have been
used by the ASET nurse to determine the depression level of Max. GDS is an assessment tool
consisting of a number of close-ended questions to be answered with only yes or no (Guerra,
Ferri, Llibre, Prina & Prince, 2015). These questions help to gather relevant information to assess
the level of depression of the patient. It is not recommended to keep depression untreated, as it is
likely to give rise to suicidal thoughts. It was identified that apart from depression, Max is also
suffering because of his knee and recently went through a knee surgery. He was admitted due to
bleeding and even post treatment there was swelling. It can be said that Max was going through
pain associated with his knee injuries. It is unacceptable how a RN did not initiate further queries
to assess the level of pain of Max. It is important to assess the pain level among aged people as
with age chronic pains start to show up, and with added injury pain, it can make a negative
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impact on the patient (Holloway, Parker & McCutcheon, 2018). NRS pain assessment tool could
have been applied on Max to help him combat with this physical health issue.
During the assessment it came out that Max used to consume alcohol on regular basis. Moreover,
he continued to follow a particular drinking pattern throughout his life. Aged people like Max
should limit their alcohol consumptions in order to maintain good health. Robyn was so focused
on building rapport with patient that she passed the vital point of making Max aware about his
alcohol intake. She gathered relevant information but was unable to provide him with any fruitful
advice in this particular field. Being in hospital can cause alcohol withdrawal which can cause
severe health consequences to the patients, especially the aged people (Mirijello et al. 2015). The
nurse could have enabled proper risk assessment on Max regarding alcohol withdrawal by using
AWS (Alcohol Withdrawal Scale) and ensured that needful measures are at place to help him
recover.
Strength Based Assessment
Strength based assessment in an integral tool which is used to empower the affected people for
self-aid. In strength based assessment, the existing strengths of the person are identified and the
person is motivated to use those strengths to attain recovery. For an aged person, external
interventions are not adequate to ensure overall recovery (Levant, Chari & DeFrances, 2015).
Self-motivation is the key as it helps them to assess their skills and enable them to make the most
of it. Strength based assessment allows the affected person to come up with the most suitable
approach to generate mental and physical wellness (Nichols & Graves Jr, 2018). From the
assessment conducted by Robyn, it is evident that Max is having a number of major to minor
issues. As for major issues, pain can be considered as the most prominent one. Pain caused from
the knee injuries of Max can be a major reason behind different associated factors of his health
and lifestyle. It can be a reason why Max does not like to socialize much as pain keeps him from
meeting his friends. At times, excessive pain causes people to see blurry images which they
consider as impaired vision. It is also a major cause of mobility problems as swelling of knee
affects normal movement of people (Gustavsson, 2017). The condition can be more critical if the
person is more than 60 years old.
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An effective effort from Robyn could have resulted in further discussion and proper analysis of
the pain from which Max was suffering. The overall conversation between Robyn and Max was
more casual. It required more clinical connection based on Max’s health. Robyn could have
performed a more critical analysis on the health issues and regular habits of Max and provided
him with suitable measures to combat with the same. Although Robyn was seen motivating Max
to go for check-up to identify early symptoms of health issues and adopt needful medical
interventions to prohibit the same, it seemed like she was more focused on building rapport with
the patient rather than critically questioning the patient and finding out the root of the health
problems. Robyn should have critically questioned Max regarding his pain, alcohol intake,
hearing impairment and make him understand about the necessities of controlling alcohol intake,
using hearing aid, and effectiveness of medical consultations regarding his knee pain or utility of
support to walk in order to initiate health improvements in him. All these are important to help
Max in taking informed decision about own health.
Conclusion
This assessment reflected the condition of an elderly patient Max and the efficiency level of
Robyn, a Registered Nurse in charge of conducting the assessment. A number of factors
associated with the health of Max has been identified and analysed in this study. Suitable clinical
tools are also recommended to improve the condition of the patient. The assessment would be
helpful for the readers to understand the age related factors which are responsible for causing
barriers of effective communication. Those barriers are identified and are discussed by
addressing the case of Max. A thorough strength based analysis is also provided in context of the
same, application of which will enable Max to take informed health related decisions.
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References
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