All nursing students are required to meet the seven standards produced by the Nursing & Midwifery Council (NMC) before being entered onto the professional register. Fundamentals of Assessment and Care Planning for Nurses addresses two of these important standards, helping readers become proficient in assessing patient needs, and planning, providing and evaluating care.
This timely publication adopts a practical approach with NMC proficiencies at its core, providing guidance and insight into the application of key skills and demonstrating competency in real-life settings.
* Centres around a fictitious nuclear family to provide a practical basis to the various chapters and assessment
* Offers mnemonics to enable comprehensive history taking and systematic physical assessment
* Helps readers address socio-cultural considerations they may face in practice
* Includes links to literature that provides further support and additional information
Fundamentals of Assessment and Care Planning for Nurses is an important resource for pre-registration nursing students and Nursing Associates who are required to demonstrate proficiency in the new NMC standards, and other registered practitioners seeking to update their knowledge.
Ian Peate, OBE FRCN is Visiting Professor of Nursing, Visiting Senior Clinical Fellow, Editor-in-Chief of the British Journal of Nursing, and Head of School, School of Health Studies, Gibraltar.
The nature of nursing
The aim of this chapter is to introduce the reader to the nature of nursing and offer an overview of how care is offered.
By the end of the chapter the reader will be able to:
- Provide a timeline outlining key points in the development of contemporary nursing practice
- Identify how care provision over the years has impacted on contemporary practice
- Discuss how the NHS was formed and its current role in the provision of health and social care
- Consider local, national, and international care perspectives
The past is where lessons have been learnt and the future is where those lessons learnt are applied. However, living in the past can hinder progress. In an unidentified source, 'you cannot tell where you are going unless you know where you have been' is the key theme of this chapter. Much is to be learnt from the past in order to help us in the future, to learn from our mistakes and to help us and the services we provide to develop in an appropriate and patient-centred manner.
Before the mid-nineteenth century, nurses, whether employed in hospitals or in private homes, were very often uneducated and usually had no formal training. In Britain in the 1840s nursing sisterhoods were founded to improve standards of nursing, these mimicked the Catholic nursing orders in other European countries. St John's House, an Anglican Nursing Sisterhood founded in 1848, was one example of these. As a thank-you to Florence Nightingale for her accomplishments during the 1854-1856 Crimean War, a fund was raised by public donations to allow her to establish a training school for nurses in London, the Nightingale School set up at St Thomas' Hospital in 1860. Other hospitals, both voluntary hospitals and workhouse infirmaries, formed their own training schools, and many of these were run by superintendents who had trained at the Nightingale School. Nightingale based her curriculum on the following beliefs:
- Nutrition is an important part of nursing care.
- Fresh, clean air is beneficial to the sick.
- Sick people require occupational and recreational therapy.
- Nurses should help identify and meet patients' personal needs and these include the provision of emotional support.
- Nursing should be directed towards two conditions: health and illness.
- Nursing is separate and distinct from the practice of medicine and as such should be taught by nurses.
- Nurses need continuing education.
Think about the list of Nightingale's beliefs (those that were a part of her nursing curriculum) and reflect on the course or programme of study you are enlisted on and determine if these beliefs are still the foundation of nursing education today.
Provision was also provided to train district nurses to care for the sick and poor in their own homes, and in 1887 the Queen's Institute of District Nursing was founded.
The 1919 Nurses Registration Act set up the General Nursing Council, which was charged with maintaining a register of nurses to ensure that in future all nurses were appropriately trained. As a result of a shortage of nurses, the Nurses Act established in 1943 provided a roll of assistant nurses.
In 1930 county councils took over the workhouse infirmaries from the Boards of Guardians and the London County Council also acquired all the hospitals that had been previously managed by the Metropolitan Asylums Board. Most hospitals and mental institutions in 1948 passed to the National Health Service (NHS), with the majority of them becoming the responsibility of the regional hospital boards. Four boards assumed responsibility in London and the South East, as well as the North East, North West, South East, and South West Metropolitan Hospital Boards. In each hospital region an Area Nurse Training Committee was established, with the aims of financing, advising and improving all nurse training institutions in the region.
County councils became responsible for district nursing as well as for other personal health services in 1948. All health services were transferred to the newly formed regional and area health authorities in 1974, replacing the regional hospital boards, and in 1982 area health authorities were abolished. There have been numerous other reorganisations that have followed.
The National Health Service
The NHS is over 70?years old, and the NHS and those people it offers a service to today are very different now than in 1948 when it was born. This difference between then and now must be taken into account in any discussion that includes contemporary service provision. Today Britain has become a wealthier society, it is more socially and morally liberal and as a result of this, public expectations have changed considerably. However, the impact that social and economic changes have had on society have been uneven, and there are inequalities.
The NHS was created out of the notion that good healthcare should be available to all, irrespective of wealth. When the NHS was launched on 5 July 1948, it was based on three core principles, that it:
- Meets the needs of everyone
- Be free at the point of delivery
- Be based on clinical need, not ability to pay
(the National Health Service Act - see figure 1.1).
Figure 1.1 The National Health Service (NHS) Act 1946.
These three principles are still very apparent today, they continue to guide the development of the NHS and remain at its centre. The NHS is the largest employer in the UK, there are roughly 1.5 million people employed by the NHS across the UK. By country:
- In England 1.2 million
- In Scotland 162?000
- In Wales 89?000
- In Northern Ireland (NI) 64?000
This data does not include everyone working in the health sector. They leave out some people, for example temporary staff, GPs, dentists, optometrists, and other staff in the independent sector or private hospitals (Full Fact 2017).
In England, around 824?000 clinical staff (those directly involved in patient care) work in the NHS, including 141?000 doctors and 329?000 nurses, midwives and health visitors (National Audit Office 2016).
The NHS was launched in 1948. It was born out of a long-held ideal that good healthcare should be available to all, regardless of wealth. The NHS provides healthcare for all UK citizens based on their need for healthcare as opposed to their ability to pay for it. It is funded by taxes.
The NHS is the largest employer in the UK - there are around 1.5 million people employed by the NHS across the UK.
Department of Health and Social Care
The purpose of the Department of Health (DH) is to help people live better for longer, the DH shapes and funds health and care in England, ensuring that people have the support, care and treatment they require, with the compassion, respect and dignity that they deserve. The dynamic and changing health and care organisations work together with the DH to achieve this common purpose. In 2018 the Department of Health became the Department of Health and Social Care (DHSC).
The DH facilitates health and social care bodies to deliver services according to national priorities, working with other parts of government to achieve this and setting objectives and budgets and holding the system to account on behalf of the Secretary of State for Health. Ultimate responsibility for ensuring that the whole system works together to meet the needs of patients and the public sits with the Secretary of State for Health. Figure 1.2 provides a visual overview of the DH.
Figure 1.2 The Department of Health (DH) explained.
Source: DH (2013) (permission open government licence: www.nationalarchives.gov.uk/doc/open-government-licence/version/3).
NHS England assists NHS services nationally ensuring that money spent on NHS services provides the best possible care for patients. It funds local clinical commissioning groups (CCGs) to commission services for their communities and ensures that they do this effectively. NHS England brings together expertise to ensure that national standards are consistently in place across the country. Throughout its work it promotes the NHS Constitution and the Constitution's values and commitments.
Clinical commissioning groups
These are clinically led statutory NHS bodies responsible for the planning and commissioning of healthcare services for their local area. Membership of CCGs includes nurses and other clinicians, such as GPs and consultants. They are responsible for approximately 60% of the NHS budget and commission the majority of secondary care services as well as playing a part in the commissioning of GP services.
Health and wellbeing boards
Health and wellbeing boards (HWBs) were established by local authorities to act as a forum for...