Outpatients Workbook - Staff Personal · PDF fileOutpatients Workbook Student Name ... the nursing staff will plan the patient’s care. ... Proprietary name Mode of action Route of

OPD WORKBOOK 4 Christine Ely Page 1 28/02/2003

Outpatients Workbook

Student Name Cohort Module Placement dates


Contents of the workbook

AIMS OF THE WORKBOOK........................................................................................... 3

THE ROLE OF THE NURSE IN OUTPATIENTS DEPARTMENTS. ........................ 4

LEGISLATION.................................................................................................................... 6

NURSING ASSESSMENT OF PATIENTS PRIOR TO CONSULTATIONS IN OUTPATIENTS................................................................................................................... 7

BLOOD TESTS.................................................................................................................... 8

INVESTIGATIONS............................................................................................................. 9

URINALYSIS..................................................................................................................... 10

PLANNING CARE IN OUTPATIENTS......................................................................... 11

DEALING WITH THE ANXIETY OF WAITING FOR A CONSULTATION......... 12

SUPPORTING PATIENTS DURING CONSULTATIONS ......................................... 13

PATIENTS RESPONSE TO BAD NEWS ...................................................................... 14

CONDITIONS ENCOUNTERED IN OPD..................................................................... 16

DRUGS USED IN OPD CLINICS ................................................................................... 17

REFERRALS AND FUTURE APPOINTMENTS......................................................... 18

REFLECTION ................................................................................................................... 19

REFERENCES................................................................................................................... 21

NOTES................................................................................................................................ 22


Aims of the workbook This workbook should be included, as part of your evidence of learning for your Practice Based Assessment and on return to you after marking, by your personal tutor, this should be placed in your Portfolio document. You do not have to complete the workbook sequentially and may start at any section that links to your experiences in Out Patients Department (OPD). You

should write in this book and this sign indicates an activity for you to complete. The workbook provides you with some structured questions for you to answer and other information. It concludes with a reflection exercise, which should help identify your learning from this placement. The staff in OPD can help you to find the answers to the workbook questions. You should also discuss your progress, with this workbook, with your mentor who can direct you to the other learning resources that can be a source of information.


The role of the Nurse in Outpatients Departments. The model of nursing developed by the theorist Hildergard Peplau identifies that nurses at different times assume specific roles to meet a patient’s needs. These professional roles require the use of interpersonal skills to achieve positive changes that enhance the patient’ s recovery (Simpson, 1991). The roles in Peplau’s model are identified in the table below.

From your observations in OPD, give one example of each these roles demonstrating a sensitive/appropriate approach to patients or staff needs. Peplau’ Role Your experience or observation of

how the nurse managed this role positively.

Stranger -one who meets the patient as stranger.

Teacher – one who imparts knowledge concerning a need or interest

Resource – One who provides specific, needed information that aids in understanding of a problem or a new situation.

Counsellor – one, who, through the use of certain skills and attitudes aids another in recognising, facing, accepting, and resolving problems that are interfering with the other person’s ability to live happily and effectively.


Leader One who carries out the process of initiating and maintaining of group goals through interaction

Technical expert – One who provides physical care by displaying clinical skills and operating equipment in this care (Belcher and Fish, 1995)

Surrogate – One who takes the place of another


Legislation (this links with learning outcome 1, module 2)

Explain the meaning of the term ‘legislation’ in one to two sentences?

In the following list, tick any, which are items of legislation? Answers at the bottom of this page.

1. Manual Handling Operations Regulations 1992 [ ] 2. The Patients Charter 1991 [ ] 3. Health and Safety at Work Act 1974 [ ] 4. Nursing and Midwifery Council Code of Conduct 2002 [ ] 5. Display Screen Regulations 1992 [ ] 6. Control of Substances Harmful to Health Regulations 1994 [ ] 7. Infection Control Policy [ ] 8. Access to Medical Records Act 1990 [ ] 9. Data Protection Act 1984 [ ] 10. Misuse of Drugs Regulations 1985 [ ]


Nursing Assessment of patients prior to consultations in outpatients. Nursing assessment is concerned with gathering information. Nursing assessment is the first step in the nursing process when objective and subjective information is obtained for the purpose of identifying actual and potential problems. Recordings of physiological measurements, such as blood pressure, urinalysis, weight, and height, can provide objective data. Subjective data can be obtained by verbal questioning and observing behaviour.

Why is it important to assess patients for any visual or hearing problems or mobility problems when they arrive in outpatients?

How would you assess the patient’s ability to communicate verbally in English?

Why is it important to assess the patient’s psychological state and mental abilities?


Blood Tests What Blood tests might need to be completed prior to consultation and

why? Blood test Rationale for this.


Investigations Note any investigations, such as types of X rays, ultrasound and E.C.G.’s,

which you have observed. Investigation Briefly explain what this investigation

entails.


Urinalysis You will during your experience in OPD test patients’ urine. This investigation may detect abnormalities that indicate a disease.

Explain what the different indicators on the reagent strips mean? Reagent test Rationale for this. ph

Protein

Glucose

Ketones

Blood

Bilirubin

Urobilligen

Specific gravity


Planning care in outpatients Planning is the second stage in the nursing process and this will ensure that the patient in OPD is prepared for consultation with the doctor as quickly as possible. Clinics must be planned effectively to help reduce patient waiting-times. When the patient is assessed, on arrival to the department, the nursing staff will plan the patient’s care. This is not formally written down as in a ‘care plan’ on a ward as the patient is usually only in the clinic for a short period of time. However, mentally the nurse in charge of the clinic will plan the activities that need to be undertaken before the patient’s medical consultation. The nurse must organise any necessary investigations, ensure that the required observations are taken and recorded, and ensure that the patient’s notes, X-rays and results are ready. It is important to deliver care in a systematic and equal manner to ensure quality care and maximum effectiveness of professionals’ time and other resources. Roper et al (1996) note that cost effectiveness of care is crucial in hospital services,

Give an example of how one patient’s care was effectively planned in OPD.


Dealing with the anxiety of waiting for a consultation Anxiety can be generally defined as –“ a vague, unpleasant emotional state with the qualities of apprehension, dread, distress, and uneasiness” (Reber, 1995:45). Having to cope with a medical diagnosis is a threatening experience as patients may be faced with loss of their mobility, ability to work or even their life (Bennett, 2000).

Give an example of how a patient might express anxiety when attending OPD. It is essential that you always welcome your patient with a friendly smile and greet them by name in a manner that will allay anxiety (Edmondson, 1996). Nurses in OPD should aim to reduce anxiety and stress by helping the patient with positive coping mechanisms.

Briefly describe ways of reducing the stress in the waiting room


Supporting patients during consultations

Why is it necessary to chaperoning patients during consultations with doctors? Ley (1997) cited by Bennett (2000) notes that patients have sometimes poor recall of memory from medical consultations and one reason for this is that patients do not understand the information given. Errors in the patient’s understanding are more likely to occur when the patient’s views are not explored.

How else could information be given to patients that would improve their understanding? It is important that patients are empowered to ask questions otherwise they may not get the level of information they need. Pitts (1998) citing studies by Cassileth et al (1980) and Fallowfield et al (1995) notes that doctors generally underestimate not only the quantity of information required by patients but also the type of information needed.

Give an example of how a nurse may empower or encourage a patient to ask questions during the consultation.


Patients response to bad news The consultation may include giving bad news to patients. Some of the initial responses to bad news may be – shock, disbelief, denial and anger. These are part of the bereavement process when a person adjusts to loss and this can be proportional to the degree of the loss. Murray Parks (1972) outlined this process of bereavement, which over time leads to other feelings such as guilt and depression (cited by Roper et al, 1996).

Outline ways of supporting clients who have received bad news that you have either observed or used in OPD.


Evaluating care in OPD It is important to monitor the quality of care to determine what strategies are effective and where practice can improve. Discuss with your mentor and other staff how they evaluate the quality of care that is given.

Briefly discuss ways of ascertaining how a patient has had a valuable experience in OPD


Conditions encountered in OPD For the patients conditions seen in the clinics complete the following table by explaining briefly in column 2 what

condition is from your understanding Condition Your explanation of the condition


Drugs used in OPD clinics Use the following table to keep a record of six drugs that you have observed being prescribed in OPD

Pharmaceutical name

Proprietary name Mode of action Route of administration

Usual dosage Side effects and complications

Christine Ely Page 18 28/02/2003

Referrals and future appointments

Name 3 agencies that patients might be referred to from outpatients.

What sort of written information is given regarding future appointments?

Why might a patient need to be transferred to a ward instead of discharge home?


Reflection There are many different views of what reflection is (Ghaye and Lillyman, 2000) but in this instance the following definition from Boud, Keogh and Walker (1985) might be useful to give direction to your review of your placement in Outpatients. Accordingly reflection can be considered …

A generic term for those intellectual and affective activities in which individuals engage to explore their experiences in order to lead to new understandings and appreciations. (Boud et al, 1985:19)

Reflection is about recognising the learning that you have had from experience and identifying how you will use this to improve your practice in the future. As learning can be considered as the acquisition of knowledge, skills and attitudes (Jarvis, 1995) this can be used as a structure for your personal reflections.

Knowledge

What have you learnt?

How will you use this learning in the future?


Skills



Attitudes




References Belcher, J. R. and Fish, L. J. B. (1995) Hildegard E. Peplau. In: George,

J.B. ed. Nursing Theories – The Base for Professional Nursing Practice. 4th ed. London: Prentice Hall International

Bennett, P. (2000) Introduction to Clinical Health Psychology

Buckingham: Open University Press.

Boud, D., Keogh, R. and Walker, D. (1988) Promoting Reflection in: Learning: A model. In: Boud, D., Keogh, R. and Walker, D. Eds. Reflection: Turning Experience into Learning. London: Kogan Page.

Edmondson, M. (1996) Pre-assessment for Day Care. In: Penn, S.,

Davenport, H.T., Carrington, S. and Edmondson, M. Principles of Day Surgery Nursing. Oxford: Blackwell Science.

Ghaye, T. and Lillyman, S. (2000) Reflection: Principles and practice for

healthcare professionals. Wiltshire: Quay Books Mark Allen Pub.Ltd.

Jarvis, P. (1995) Adult and Continuing Education: Theory and Practice 2nd

ed. London: Routledge.

Pitts, M. (1998) The Medical Consultation. In: Pitts, M. and Phillips, K. eds.The Psychology of Health – an introduction. 2nd ed. London: Routledge.

Reber, A. S. (1995) Dictionary of Psychology 2ND ed. London: Penguin.

Roper, N., Logan, W.W. and Tierney, A.J. (1996) The Elements of Nursing– a model for nursing based on a model of living 4th ed. Edinburgh: Churchill Livingstone.

Simpson, H. (1991) Peplau’s model in action. Basingstoke: Macmillian.


Notes

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Outpatients Workbook - Staff Personal · PDF fileOutpatients Workbook Student Name ... the nursing staff will plan the patient’s care. ... Proprietary name Mode of action Route of