PATIENT NEEDS AND EFFECTIVE NURSING COMMUNICATION

Running head: PATIENT NEEDS AND EFFECTIVE NURSING COMMUNICATION
PATIENT NEEDS AND EFFECTIVE NURSING COMMUNICATION
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1PATIENT NEEDS AND EFFECTIVE NURSING COMMUNICATION
Introduction
According to professional standards 7, formulated by the Nursing and Midwifery Council
(NMC, 2019), registered nurses (RNs) are required to established clear communication patients,
their families and associated health professionals for the purpose of sharing relevant information
on patient needs and preferences. A key procedure with which nurses can identify the needs of
patients and initiate effective communication regarding the same, is the Roper-Logan-Tierney
Model for nursing which is based on the assessment of a patient’s ability to perform activities of
daily living (ADL) (Williams 2017). The following essay, will discuss the role of effective
nursing communication via the Roper-Logan-Tierney Model for Nursing, with respect to a
specific patient case scenario.
Discussion
Context of Patient Admission
The following essay will be based on a patient who was admitted in the context of a
musculoskeletal disorder diagnosis (osteoarthritis) and thus, inability to address the health need
of ‘mobilization’ or the ability to be mobile to practice mobility within the range of motion. The
concerned patient is Mrs. X (name of the patient kept confidentiality as per the Standard 5 of the
NMC Code) – a 60 year old woman who was admitted upon complaints of debilitating pain in
both of her knees, which has progressively worsened since the last 3 years. The patient reported
of feeling stiffness and pain in her knees, every day when she woke up in the morning, which
lasted for almost 20 to 30 minutes. She also experienced knee pain and stiffness several times
throughout the day, especially when she arose after sitting for a prolonged time or when she
remained in the same position for a long period of time. While resting and sitting temporarily

2PATIENT NEEDS AND EFFECTIVE NURSING COMMUNICATION
relieved her pain, the same would worsen especially during days which were humid or cold or
while participating in participating in particular movements like climbing the stairs or squatting
to pick up an item – thus indicative reduced mobility.
A physical musculoskeletal examination revealed a diagnosis of osteoarthritis in the form
of a lack of complete knee flexion and extension of less than 120 degree as compared to the
normal range of 140 to 150 degrees respectively (Yousif and Altaee 2018). An additional
radiological X-ray assessment revealed narrowed joint space and loss of cartilage across the
joints in both of her knees. Further assessment revealed that Mrs. X lived with her 65 year old
husband and that both her daughter and son were married and lived away with their respective
families. Due to progressive knee pain, Mrs. X now spends most of her time at home with her
husband doing most of the cooking, cleaning and grocery shopping for her. While she encounters
no problem concerning dressing, grooming or hygiene – she admits to feeling lonely and bored
since her knee pain has restricted her ability to meet her friends during their weekly gatherings.
Considering the above, it can be identified that the key health need of the concerned patient is the
need to practice the ADL of effective mobilization (Williams 2015).
Identification of Health Need
The NMC Code component of ‘Practice Effectively’ recognizes the importance of the
nursing practice of assessing patient needs, with the help of a evidence based, comprehensive
patient screening and assessment tools (NMC, 201). Thus, the health need of the concerned
patient will be identified and assessed with the help of the Roper-Logan-Tierney Model for
Nursing. This model of nursing assists nurses in the development of a nursing care plan using
theoretical perspectives associated with ADLs. This nursing model was formulated by Winfred
W. Logan, Nancy Roper and Alison J. Tierney (Nelson and Welsh 2015). The aim of this model

3PATIENT NEEDS AND EFFECTIVE NURSING COMMUNICATION
is to measure the effect of disease progression or deterioration on a patient’s level of
independence during performance of ADL following which, a nurse can implement specific
health interventions targeting the affected ADL. Thus, the key ADLs which are targeted by
Roper-Logan-Tierney Model are: communication, maintenance of safety, eating and drinking,
breathing, temperature controlling, washing and dressing, elimination, sleeping, working and
playing, and lastly, mobilization (Nelson and Carey 2016).
Considering the above scenario where the patient has been in the context of a diagnosis
of osteoarthritis and affected movement due to worsening pain and stiffness in both her knees, it
is evident that the ADL which has been affected as per the Roper-Logan-Tierney Model for
Nursing, is mobilization. The ADL of mobilization is the name given to the activity of mobility,
that is, the act of moving from one place to another (Holland and Jenkins 2019). Thus, the health
need of the concerned patient is the need to regain mobility, that is, perform the ADL of
mobilization. Mobilization is particularly essential for daily life functioning like walking and
participation in outdoor activities and thus, inadequacy in the same severely impacts an
individual’s ability to socialize. Thus, the nursing care plan to be developed for Mrs. X, must be
centered on restoring her need to fulfil the ADL of mobilization (Turan and Sendir 2019).
Standard 3 postulated by the NMC, necessitates the importance of RNs conducting a
comprehensive assessment of the physiological, psychological, emotional and social needs of the
patient (NMC, 2019). The absence of a comprehensive and holistic patient assessment hinders
nursing ability to effectively communicate patient needs and formulate and evidence based care
plan and interventions – thus hindering effective therapeutic nurse-patient relationship
(Imanipour and Jalili 2016).

4PATIENT NEEDS AND EFFECTIVE NURSING COMMUNICATION
The Roper-Logan-Tierney Model address the importance of comprehensive assessment
of patient needs via evaluating the influence of five key influencing factors which impact an
individual’s ability to engage in ADLs (Nelson and Welsh 2015). Thus, according to this nursing
model, these five factors influence Mrs. X’s ability to engage in her ADL in the following ways
(Williams 2015):
 Biological factor, or the influence of her disease and health status in her ability to engage
in the ADL of mobilization. In this case, the RN must take into consideration
interventions targeting her osteoarthritis since it has extensively influence her knee pain
progression since the last 3 years.
 Psychological factor or the influence of patient’s cognitive abilities and emotions on his
or her ADL performance. While Mrs. X does not demonstrate any issues in her mental
health status, her inadequate levels of health literacy regarding her condition as well as
her feelings of boredom and loneliness may negatively impact her ability to recover
mobilization.
 Sociocultural factors or the influence of societal and cultural perceptions which may
affect the patient’s ability to participate in ADLs. With this respect, the societal
perception of associating social engagement with good health may motivate Mrs. X to
comply to her care plan.
 Environmental factors or the influence of the patient’s surroundings on his or her ability
to participate in ADL. With this respect, the presence of obstacles, hazards or even
establishment of railings or bars must be considered in Mrs. X’s home since these can
affect her mobilization.

5PATIENT NEEDS AND EFFECTIVE NURSING COMMUNICATION
 Politicoeconomic factors or the role of governmetal policies on the patient’s ADL
participation ability. Thus, the RN must consider Mrs. X’s financial status and the role of
Medicare in assisting her with meeting all her care plan and medication needs.
Nursing Role and Patient Health Need
Thus, considering the above, the identification and assessment of the health need of Mrs.
X was actively performed by the RN. In order to identify the health need of Mrs. X, the RN after
obtaining her consent, compassionately communicated with her on her ability to participate in
selected ADLs using the Roper-Logan-Tierney Model (Nelson and Carey 2016). Such
communication methods appropriately comply with NMC Standard 1 of treating patients in a
compassionate and dignified manner (NMC, 2019). Additionally, Mrs. X was also actively
encouraged by the nurse to share her personal view and decisions regarding her ADL
performance and her expectations concerning the care plan and related interventions. Such
nursing communication practices demonstrate the nursing role of patient centeredness, that is, the
nursing practice of encouraging patients to actively take part in the care plan decision making
process (Lor, Crooks and Tluczek 2016). The importance of nursing role of patient centeredness
and patient empowerment also comply with NMC Standard 2 of actively listening and allowing
patients to share their concerns and decisions regarding their health (NMC, 2019). The nursing
role of patient centeredness have been evidenced to effectively assist in the identification of
patient needs since it makes the patient feel empowered, respected and dignified which further
encourages the patient to eagerly share his or her concerns (Bachnick et al., 2018).
Additionally, the association between the identified health need and patient performance
of ADL was further comprehensively assessed by the RN with regards to Mrs. X, via further
holistic biological, psychological, sociocultural, and environmental and politicoeconomic

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assessments – again by using the Roper-Logan-Tierney Model. Without such comprehensive
assessment, as denoted by the creators of the model themselves, the patient will be deprived of a
holistic assessment, which can further result in deliverance of incorrect or inappropriate nursing
interventions (Holland and Jenkins 2019).
Indeed, it has been evidenced that, a lack of comprehensive assessment of all the
biopsychosocial needs of the patient, not only raises the risk of medical errors but also prevents
the achievement of positive health outcomes (Zhang et al., 2016). Further, NMC Standard 3 also
demonstrates the importance of the nursing role of completely assessing the psychological,
physiological, emotional and social needs of the patient followed by usage of this information to
initiate patient centered communication and development of an evidence based nursing care plan
(NMC, 2019). Thus, it is for these reasons by which the nursing role of conducting holistic,
comprehensive assessments resulted in identification of the above identified Mrs. X’s needs of
mobilization and its associated biological, psychological, sociocultural, and environmental and
politicoeconomic influencing factors.
MDT Member
According to NMC Standards 8 and 9, RNs must value, understand and practice the
importance of working cooperatively and respecting the practice of additional health
professionals for the purpose of improving patient practice (NMC, 201). Clearly, this NMC
Standard relates to the importance of nursing practice in collaboration with multidisciplinary
health professionals. Despite the comprehensive nature of nursing activities, a patient’s health
and disease status may still demand additional, evidence based clinical interventions which are
beyond the nurse’s scope of practice. It is for this reason why healthcare organizations must
consider the participation of both nurses and multidisciplinary teams (MDTs) for effective

7PATIENT NEEDS AND EFFECTIVE NURSING COMMUNICATION
patient interventions and recovery (Ndosi et al. 2017). Thus, with this respect, the key MDT
member who was identified for ensuring that Mrs. X’s healthcare need was met, was an
occupational therapist.
Osteoarthritis, as observed in the case study, has been evidenced to hinder patient
mobility – which is clearly demonstrated in Mrs. X’s healthcare need of practicing mobilization.
The role of an occupational therapist as a part of the MDT team has also been evidenced to be
useful in enhancing movement in an osteoarthritic patient. An occupational therapist is a
healthcare professional who corrects mobility issues in patients via educating patients on patients
on lifestyle and home-based modifications like exercise and provision of assistive devices like
splints and supportive equipment (Prior et al. 2017). Thus, for this reason, the role of an
occupational therapist was identified as essential in the MDT team for Mrs. X’s care plan, who
further assisted her in meeting her health need of mobility by teaching her appropriate stretching
and strength based exercises, as well as educating her husband on importance of using protective
aids like knee protectors at home. Such nursing collaboration with an identified MDT for patient
and family communication demonstrates compliance to NMC Standard 5.5 which instructs RNs
to share required healthcare information with patients and their families (NMC, 2019).
Effective Communication
Nursing collaboration with an MDT professional significantly helps in improving
effective communication with patients as well as in the identification of patient needs. This is
because each patient presents with a unique and complex set of health and disease issues which
may be beyond the scope of nursing practice (Warburton and Ryan 2018). Indeed, the RN
assessment using Roper-Logan-Tierney Model successfully resulted in identification of Mrs. X’s
healthcare need of mobilization, it was only after inclusion of the role of an MDT member, an

8PATIENT NEEDS AND EFFECTIVE NURSING COMMUNICATION
occupational therapist, which truly assisted implementation of interventions specifically targeting
her mobility.
Additionally, nursing practice of patient centered and family centered approaches
significantly improve effective communication between nurses and patients. This is because
encouraging direct participations of patients and families in the decision making process not only
induces feelings of comfort and security in patients and families, but also helps in development
of a care pan customized to the specific needs of the patient (Goldfarb et al. 2017). Indeed, it was
only after inclusion of Mrs. X’s opinions was the RN able to identify her healthcare need of
mobilization in consideration with her sociocultural factors concerned with her wish to partake in
outdoor activities.
Conclusion
Thus, this paper successfully discusses the importance of effective communication, the
role of an MDT member as well as performance of comprehensive assessments in the
identification of specific patient needs and development of individualized care plans. With this
respect, usage of assessments like the Roper-Logan-Tierney Model for Nursing assisted in
identification of mobilization needs in an osteoarthritic patient. To conclude, nursing usage of
patient centered and family centered approaches assists significantly in initiating effective
communication.

9PATIENT NEEDS AND EFFECTIVE NURSING COMMUNICATION
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