PCA2: Assessment for People with Complex Needs - Nursing Assignment

This assignment is a comprehensive report focusing on the assessment and care of a 26-year-old woman, Muno, diagnosed with cerebral palsy and exhibiting complex needs. The report begins with consent and confidentiality considerations, followed by an assessment using Roper, Logan & Tierney's Activities of Living Model, focusing on communication, eating and drinking, sleeping, and mobility. The assessment highlights Muno's nonverbal communication methods, challenges with eating and swallowing, sleep disturbances, and mobility limitations. The report identifies a key health need—the need for regular exercise—and outlines the aetiology, characteristics, and impact of this need. A detailed care plan is then presented, including two interventions: special teaching techniques and the involvement of speech and language therapists. The interventions are supported by rationales and evidence-based practices, emphasizing the importance of tailored approaches to meet Muno's specific needs and improve her overall well-being. The report provides a framework for understanding and addressing the multifaceted challenges faced by individuals with complex needs in a healthcare setting, emphasizing person-centered care principles.

Person Centred Approaches 2 Supporting People with Complex Needs
Assignment- Assessment for and with People who have Complex Needs
You must follow PCA2 summative guidance for completing the workbook.
Section 1:
Consent and confidentiality: (max 200 words)
A nursing assessment took place at the Lodge after a manager and a keyworker raised
some concerns about one of the patients who is unable to eat and drink properly. In this
assignment, a pseudonym will be given to hide the true identity of service user. The chosen
pseudonym is Muno where she is a 26 years old woman, diagnosed with a condition called
cerebral palsy. According to Schmolke and Amering, (2017) [p.97.] it is identified that cerebral
palsy is a lifelong condition that affects the movement and co-ordination of body and is caused
by a problem with brain that occurs either before, during or soon after the birth. The symptoms
of cerebral palsy may include difficulty in swallowing, constipation, muscle spasms and many
more (Butcher and Wagner, 2018).
As per the scenario, a discussion took place in between health care professionals, patients
and her sister (Heller and Fisher, 2015). In the given video, consent has been received from
patient as well as her accompanying family members with the best of their interest. Also, the
nurse is responsible to undertake all roles and responsibilities that are needed to be performed to
provide effective care to disabled people.
Section 2: Assessment -> plan -> intervention -> evaluation
Assessment based on Roper, Logan & Tierney’s Activities of Living Model (1980). (max
1000 words)
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Activities of Living
Identify and prioritise 4 activities of living in relation to the individual’s health need. The word
limit for this section means that you do not need to discuss all the activities of living.
Delete the activity headings that you have chosen not to discuss
In this assignment, Roper, Logan & Tierney’s Activities of Living Model (1980) will be used to make
an assessment on Muno. The four activities of living which are going to be used are communication,
eating and drinking, sleeping and mobility.
Communication
Communication is vital and through it, people share their thoughts and feelings in different
personal, formal and social situation (Holland et al 2008). Due to Muno`s complex needs, she is
unable to communicate in words which means she is able to communicate nonverbally. According to
Royal College of Nursing, (2015) “non-verbal communication which is usually done using body
language that says a lot about getting engaged with an interest of communicating”. (Schmolke,
Amering and Svettini, 2016. (pp. 97-111). During the assessment, manager and keyworker pointed
out that Muno uses pictures, objects references and facial expressions as her means of
communication.
According to NHS, (2015) people with complex needs require support in their everyday lives.
People with complex needs require support of activities in their daily living; they might find it
challenging, exchanging and passing on information using pictures and body language to support their
communication (MacArthur and Fletcher, 2015). However, there are many communication aids which
help but they do not express the individual`s emotions Kennedy and Brewer (2014). Communication
is difficult when individual has difficulty in expressing their choices and struggles to understand the
information Regnard et al. (2003).
Eating and Drinking
In the nursing assessment, it was highlighted that the main cause of concern was that Muno is
not eating well; she is only eating small amount of food, coughing, not having appetite and as a result,
she is losing weight. It is essential to maintain the body by eating a balanced diet. Brooker and Waugh
(2013) highlighted that each person is recommended to have 1500mls of fluids per day, whereas,
Muno is not drinking much which contributes to her constipation as it was mentioned in the meeting
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that Muno is taking movicol.
In the nursing assessment, it was mentioned by the key worker that Muno was given with
medication in her food. However, the nurse highlighted that this is a bad practice as Muno should be
given with some of the medications; at least 30 minutes before (Heller and Hsieh, 2014). Caroline
highlighted that some of the medicines which delay swallowing process or increase salivation might
impact on swallowing function. Theadom, Parmar and BIONIC Research Group, (2015) [pp.674-681]
stated that it is important to have medication review among people with learning disabilities and the
side effects might impact on their drinking, eating and nutritional habits that are needed to be
considered carefully at the time of prescribing medication. It was together stated by the nurse in the
given video that the patient Muno is fed by the staff who supports her to eat because she is more
comfortable in sitting onto a bean bag and faces difficultly in sitting to a moulded chair for eating.
Risk of poor posture during mealtime
Poor risk posture can become a risk for an individual while eating. This may can choke the
food and create serious issues for an individual. It can create swelling difficulties and choking are the
key areas of concern.
Sleeping
It was highlighted that Muno does not sleep much during the night; she tends to sleep more
during the day. Roper et al stated that sleep allows the body to relax from all stresses of everyday
activities and also leads to the growth and repair of cells, during the sleep Roper et al. (1999, 2000)
highlight that sleeping is vital for everyone and therefore, it is an important Activity of Living. The
keyworkers suggested that Muno might not be sleeping well because of the muscle spasm. There
could be some related issues that might be affecting Muno’s sleeping pattern such as feeling tired and
not eating well at meal times and also, it might be affecting her sleep pattern where she is also not
comfortable in her chair (Spear-Swerling, 2018). The nurse should consider helping Muno with the
issue. It can be suggested that it could be another reason for Muno for not being able to sleep at night
where her bedding and pillows must be checked properly. The room temperature is very important
and it is ideal to have it around 20 Celsius degrees. If the room is too warm or too cold, adjustments
can be considered. Also, a monitoring chart is required to record the temperature in her room. It will
give an evidence through monitoring chart in order to give a balanced assessment and referrals in the
future (Grimshaw, McGowan and McNichol, 2017) [pp.1169-1180] It was also mentioned that Muno
is happy when left to rest lying down.
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Mobilising
It was pointed that Muno uses moulded wheelchair and they also use a hoist to transfer her
they with other aids to help Muno with her needs (Schmolke, Amering and Svettini, 2016) (pp. 97-
111) stresses that problems with mobility are highly associated with people having physical
disabilities who have complex needs with an important need therapeutic positioning. Muno is relying
on others for the comfort and to ensure that the correct measures are taken to improve and maintain
her posture.
It was mentioned that Muno feels comfortable when lying in bed during the day. Therefore,
Muno will now missing out the activities she enjoyed by lying in bed during the day. It was
mentioned that when eating her food, she sits on the bean bag, whereby her posture is complicated,
and she will end up choking. Mencap (2016) pointed out that posture is about using right equipment
and positioning techniques. It was said that Muno does not like to be hoisted and she is not happy
sitting on her wheelchair (Mencap, 2016).
Negative effect of poor posture
There are various risks associated with the poor posture such as it can impede the ability of the
lungs to expand (Hartling, Milne and Newton, 2014). It has also become a risk factor for many
injuries and create swelling difficulty.
Section 3: Assessment –Diagnosis- plan -> intervention -> evaluation
Key Health Need / Nursing Diagnosis: (100 words)
One health need with rationale
Regular exercise is one of the health needs which is identified. It is because; Muno is not
performing any daily activities and she use to sleep in day time which lead to increase her health
issues.
Aetiology
The causes of her disease are too much consumption of caffeine and avoiding daytime
naps.
Muno has spastic cerebral palsy which affects all her four limbs. She is unable to stand
and she has a moulded wheelchair.
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Characteristics
According to Pawlyn and Carnaby, (2009) sleeping problems are also generally more in
people with learning disabilities. Not sleeping at night can negatively affect Muno in performing
the daily activities. Although, sleeping in daytime is also a reason behind her constipation related
issues Paterson (2014). It is essential for Muno to perform exercise and take all its food in time
so that health issues can be overcome (Barrett et al 2012).
Section 4: Assessment -> plan -> intervention -> evaluation
Care or Intervention Plan: (max 1200 words)
Care plan is a written document that is used to provide information about the person and also
defines the areas that care plan covers (Barrett et al. 2012).
Care of Intervention Plan
Intervention 1: Special teaching techniques
This intervention includes helping an individual to learn through multisensory
experience and provide feedback immediately to strengthen their ability of recognising things.
Action
Nurses need to use effective communication skills with respect to vulnerable people.
Along with this, a nurse can focus on home visits and attend some of the GP clinic
appointments with respect to monitoring and discussing progress with patients (Williams,
2017). Learning disable people not like to engage in social functions or event, therefore, nurses
can plan any activities or social events that help in supporting living setting.
Rationale
Reason for choosing this intervention program is that it will help in strengthening the
recognising ability and makes them confident.
Evidence based
NHS (2015) stated that people with a learning disability are likely to be underweight or
overweight; therefore people with multiple disabilities are often underweight because of poor
feeding and swallowing. Muno’s Care Plan must have strategies and techniques used for her
eating and drinking, her sitting position and proper chair when eating and must also considers
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the overall environment (Moura, and Caetano 2015).
Intervention 2 Speech and Language Therapists
Action
Muno needs to be assessed by speech and language therapists due to her swallowing
action and identifies an appropriate food texture (Williams, 2015). A care plan should be used
to manage swallowing problems in people with learning disability and it should include
drinking, eating and swallowing forms during meal times
Rationale
It was mentioned when Muno drinking fluids they add thickener; therefore, thickener
might rarely meet the hydration target necessary for good health. After taking proper care,
Mumo is still facing some health issues. Therefore, it is important to provide proper diet plan to
Muno to overcome her health issues.
Evidence
The role of a nurse is to gather information and communicate with the pharmacist so
that right procedures will be followed. The National Institute for Health and Care Excellence
(NICE) (2015) stated that if there is an immediate need covert medication should only be
administered when a management plan is in place following the formal best interest meeting.
Nursing staff to attend the meeting, the prescriber, pharmacist and the person who can
communicate the views and the interests of the patient such as a family member or independent
mental capacity advocate. The role of LD nurse is to provide proper care to patients so that they
can overcome health issues and live a healthier life (Hall, 2015).
Intervention 3
Muno is losing weight and is not eating well; thus she is frequently constipated. The role
of the learning disability nurse is to take actions for her eating problems.. The nurse is to
prepare a care plan for her and educate the family and the staff. Care plan is a written document
that is used to provide information about the person, it also defines the areas the care plan
covers
Action
Where there is a problem with eating and drinking the nurse must include what the
concern is and needs to be done. The nurse must put in place how to support Muno to eat and
drink properly and minimise risk of choking. It is also her responsibility to ensure whether
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eating and drinking guidelines are followed or not and when to seek other professionals such as
speech therapists (Butcher and Wagner, 2018).
Rationale
The duty of the learning disability nurse is to enforce and enhance the use of food and
fluid charts by applying guidelines as well as following Muno`s routine. As mentioned that she
eats her meal while sitting on the bean bag
Evidence based
The Nursing and Midwifery Council (NMC) (2010) and the Care Quality Commission
(CQC) “Have raised concerns that what should be a last resort is often regarded as normal
practice carried out of the convenience of staff, rather than the best interests of patients”. The
CQC stressed that covertly of administer medication is unlawful and it is unsafe of
administration (Care Quality Commission 2012).
Intervention 4: Dysphagia interventions nursing
Action
The nurse needs to verbalize and shows the family and staff about ways to keep her
head greater that 30-degree and its significance of doing in every shift. Along with this, nurse
will provide mouth and lip care to patient every.
Rationale
Through this intervention, nurses can overcome health issues faced by Muno.
Evidence based
According to Perez et al. (2017) Dysphagia is a medical term used to describe eating or
drinking disorders. Dysphagia may have several numbers of causes such as mechanical
problems in dealing with food or drink in mouth such as difficulty in movement, difficulty with
swallowing or chewing and preparing food for swallowing (Heller and Fisher, 2015).
According to Royal College of Nursing (2016) eating and drinking are both fundamental
to life, both of these usually takes part on daily basis and both provides great opportunities for
maintaining a healthy body.
Care plan is a written document that is used to provide information about the person; it
also defines areas that care plan covers (Barrett et al. 2012). The nurse`s care plan is essential to
educate support workers and Muno’s family about her eating, drinking or swallowing issues.
According to Paterson (2013) individuals with learning disabilities experience a lot of
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health problems as compared to normal people. Dysphagia is a dangerous and distressing
condition that leads to death to some people. Thacker et al. (2008) highlighted that swallowing
and feeding impairments are the main predictors for increased mortality and morbidity in adults
with learning disabilities.
Similarly, Chadwick and Jolliffe (2009) states that dysphagia is an issue to people with
learning disabilities and those who look after them. To prevent Muno, it is important to
minimise risk of choking, a learning disability nurse should carry out risk assessment and
records of coughing and choking incidents. It is also important for the nurse to refer Muno to a
Speech and language therapy (SALT) in order to get help with her choking. According to Royal
College of Speech and Therapists (2017), their role is to provide life-changing treatment,
support and care to children and adults who have difficulties with communication, or with
eating, drinking and swallowing.
Wright and Howseman (2013) stated that the type of food texture recommended will be
based on an individual and it depends through this process all risk has removed all risk and
better effective growth and give better services. rright and Howseman (2013). However, the
nurse must put guidelines for Muno with swallowing difficulties to the support workers must
understand the implications of her conditions, and also receive training on management
strategies and must also have a written plan. (Wright & Howseman, 2013).
Furthermore, losing weight is another action for Muno. At present, she is eating
sandwiches but not eating proper meals. A dietician might also be involved and made
recommendations to improve her diet. According to Harding and Wright (2010) stated that use
of a special seating, or drinking and eating equipment is essential. A nurse should encourages
Muno to eat high calorie foods as well food with more roughage and food and fluid is to be
considered, as well as staff to follow the guidelines (Heller and Hsieh, 2014).
It was mentioned that the staff administer Muno`s medication by putting it in her food
because she has problems with swallowing. This is called covert administration of medication.
According to Griffith (2016) Covert administration of medicines is when medication is given to
a patient without their knowledge this can be in a drink or with food. The rationale of the action
is to provide a safe way of administering medications. According to Barber (2017) support
workers or nurses has dissolved medicine in water and or in food items in order to make the
proper changes and better objective. That also helpful to make Muno healthy.
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Section 5: Assessment -> plan -> intervention -> evaluation
Evaluation: (max 200 words)
Evaluating the outcomes that helps to give better way to the nurse to work in the future.
It is critically evaluated that speech and language therapists lead to provide life-improving
treatment, support and care for people with disability (Spear-Swerling, 2018). It helps in
measuring and teaching people so that they can communicate in better manner. The
intervention goal and objective for Dysphagia need to be maintain adequate nutritional intake
in the patient to increase airway protection.
The frequency of reviewing and monitoring will depend upon the service users’ needs and
progress towards meeting goals and it will be recorded in the plan. Glasper (2013) states that
nurse and midwives must keep clear and accurate records that are relevant to their undertaken
practices. It is evaluated that nurses need to keep all records that provide consistency in the
way professionals work when supporting people. Record keeping will encourage the support
workers to be consistent and to continue support Muno. A record of food and fluid chart needs
to be kept with patient’s weight. The reason behind it is to effectively resolve the identified
issues of Muno and take proper care with assistance of an effectively designed plaAs per the
case Muno needs to get proper arrangement and best effective designed plan according to set
target goals. It helps to make better approaching target goals and best impressive goals for the
treatment of better outcomes. (Hartling, Milne and Newton, 2014).
Section 6:
Involvement of other professionals: (300 words)
Muno was referred to the team of learning disability nurses for losing weight and not
being able to sleep. A referral to the dietitian would also be beneficial to Muno. Their aim is to
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promote good health and prevent disease in each person and communities (Health Carers NHS,
2017).
It was also mentioned that she is not comfortable in her chair, for that reason, she needs
to get a physiotherapist. Role of physiotherapist is to advise and assess on exercises and
activities that can help people to remain comfortable and mobile as much as possible (Fawcett,
2007).
Muno has swallowing problem and she is at risk of choking. However, a speech and
language therapist (SALT) can support her. SALT uses different techniques that can meet an
individual` s needs such as swallowing exercises. Role of SALT in Adults with Learning
Disability is to diagnose and provide intervention to assess and give advice regarding
communication impairment which is experienced by an individual with learning disabilities
(NHS, 2015).
Other members of the MDT would need to be involved,
A General practitioner would be involved in Muno`s care. According to NHS, 2017
general practitioners focus on the complete health of a person combining psychological, social
and physical aspects of care (Williams, 2017).
Multi-disciplinary working is very important; it benefits people who need support to
get the best care possible. Munro (2011) highlighted some of the benefits of multi-disciplinary
working which are sharing information, problem solving and improved trust in between
different professionals.
The members of MDT on referring to the given case of Muno will include the health
care professional, nurses, primary care physician, neurologist, social workers and speech
pathologist (Hockenberry and Wilson, 2014). Through MDT, a more accurate assessment of
needs could be made and a suitable care package can be drawn up.
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