The purpose of this assignment is to explore the problem solving process by the four stages of APIE, and explaining their importance to nursing. Also finding out the possible problems that may occur within these stages, in relation to the video clips of Joe. Each part of the APIE process will be analysed and explore theories that might explain the behaviours of Joe and the health care professionals.
The nursing process of assessment; planning: intervention and evaluation assists health care professionals with problem solving, and advocates the personal holistic provision of care but at the patient from a holistic view, in order to provide effective care giving (Slevin 2001) then plan and set goals according to the information gathered. The plans and goals are then implemented into the care of the patient and then an evaluation can take place. Assessment Assessment is the first stage of APIE and it involves using a holistic approach to the patients’ physical, psychological and social wellbeing.
Those issues could be how the patient is, there tiredness, or how stressed they are. Also considerations should be on how the patient is psychologically (Barrett, Wilson, Wollands 2009). This functions as a baseline for the APIE process, as baselines suggests explanations that assists the health care practitioners to evaluate on the progress of the patient or if the patient is failing to reach their goals, thus leading to changes to the holistic care that is agreed Baselines are important in the assessing stage as it needs to have a clear ccount of what is happening now; as well looking at what the patient was like before the assessment. I If there are any differences then the cause for this should be recognised, so a plan could be made to find out the actual problem as well as any other potential problems that could happen. The Information taken from the patient may be objective or subjective. Objective data is measurable however, subjective data is gained from the patient, in addition to gain an understanding of them (Long, Phipps and Cassmeyer, 1995).
The concerns of wrongly assessing a patient can be that the care may not be personalised to their gender, religion and any other aspects which are important to the patient. This will then affect the way that the holistic care is implemented to the patient. The patient’s culture, values and beliefs are significant in confirming to the health care assistant what they can do to assist the patient and what the patient would like to do on their own. (Baldwin, Longhurst, Smith, et al, 2003) Planning
Planning is key to APIE as it sets SMART Goals that are patient cantered as well as including the patient as the goals are being made (Barrett et al, 2009). The concerns of the patient not being included and not getting the right information could be that the goals might not be achieved. Furthermore, any other goals that were set might not succeed. When planning care, the health care practitioner needs to consider the wishes of the patient needs and to take on board the values, beliefs and also the particular preference of the patient, as it might have an effect on their goals (Henson 1997, cited in Arnold 2003).
Without a complete assessment, the health care practitioner will not be able to proceed over the planning period successfully. Furthermore, any goals set throughout the planning stage should have a baseline of where the patient is at now in relation to the problem, as the goals will give an indication of where the patient is heading after receiving their holistic care. The goals need to be evaluated by the patient and the health care team, and so have to be measurable, observable and recordable so it can been seen if the patient is making progress towards or away from the goal.
Goals can be short term or long term dependent on the patients’ needs, however short term goals can be better for the patient as it can help sustaining the enthusiasm for reaching the outcome they wish (Barrett, Wilson, Woollands 2009). When goals are being set, it would be helpful in knowing what goals are they meant to be achieving, when are they going to accomplish it and what timeframe in which they will achieve the goal. Implementation Implementation is vital component of APIE as it puts into practice what was set out during the goal setting process.
The significance of not implementing care appropriately is that the patient might not receive the holistic care that the patient values the culture as well as the patients’ needs (Barrett et al, 2009). In addition the NMC Code (2015) states the need to treat patients as individuals as well as listening to them and responding accordingly. Once the first three stages of the problem solving approach has been completed then the evaluation process takes place. This is so the health care professionals can find out if the care of patient has been implemented correctly, and also to find out if the actual problem has been solved.
Another reason for this is to ascertain if the patient had moved closer to the goals that was set or had moved further away from them. The evidence from the goal setting questions will give health care professionals an answer to the assessment process and if this had headed towards an accurate diagnosis. Additionally, the evaluation process needs to consider if the goals that were set were realistic and related to the problem, likewise to find out if the care that was planned for the patient was implemented appropriately and lastly to reassess the problem to the patient if it has not been solved or eased (Barrett, et al, 2009).
One reason of the behaviour of Joe’s be the Cognitive Dissonance Theory (Festinger, 1954) in that in the second video clip as he articulates that he would not change anything about the implementation of the care he received and also stating that they are lovely. which illustrates co-operation of the elderly individual in the process of disengagement between them and society The statements from Joe were disputed by the fact the health care assistants kept on ignoring him when he frequently asked for his glasses. Also it appeared that the HCAs were talking over him and did not respond to his requests when they were getting him up.
Joe may be u sing cognitive dissonance as a defence meconism and also to keep the peace. Defence meconism s or other strategies can be a way for the patient to be able to deal with their problem. These plans, whether adaptive or maladaptive, should be identified although patient communication through the assessment stage. If the coping meconism is maladaptive then it should be acknowledged by the HCAs, so then goals and a plan could have be put in place ot find out the reason for hi of this behaviour and how to rectify it. It appears from the video that psychologically Joe might be at Stage Eight of Erikson’s (1980) Development.
This means that be that he is at a stage when he is assessing his life and passing on his wisdom to others, unfortunately for Joe is not able to communicate with other people in the care home as he is sat by himself at breakfast time and was being ignored by the health care assistants. According to Erikson (1980), we continue to develop until we die and with Joe being at stage eight, his strengths from the previous seven stages assemble together to evaluate his whole life. However it appears that his strengths are being broken down such as his will power, resolve and also Joe’s confidence has been dented.
In addition, Joe’s fidelity was being undermined by the fact he was called a “silly thing” by the assistant and was not being listened to when he kept asking for his glasses. Also, Joe’s autonomy is at stage two, was also being damaged as he was not given a choice of what time he wanted to get up or indicating what he wants to eat for breakfast. The example shown was that he was kept getting porridge, but on the video clip he said that when they assessed him what he would like to eat; he said fried eggs or a sausage sandwich.
This shows that the HCAs did not implement part of Joe’s assessment. In addition, it seemed that the health care assistants or the nurse did not view Joe as an individual because they did not give him the opportunity to choose what he wanted to eat, or allow him to get dressed before leaving his room. To adopt a more individualised approach, the health care assistants should have let him indicate what time he wanted to get up in a morning, and allowed him to get dressed in what he would like and further select what he wanted for breakfast.