Nutrition and Malnutrition in adult in hospital
its very important te writer read the following guidelines carfully….the essay its 3000 litrature review reseacrh,i will attached a sample essay fro the writer to have a full picture of what i want, pls i would like the writer to used Cinahl database for the litrature search, add maximum of 5 primary research aticle minimum of 2, the rest could be secondary research articles…everything have to link to uk NHS practice….INTRODUCTION
In this you need to identify the topic, the subtopic, why the subject chosen is important (not from a personal point of view), and what themes will be covered.
LITERATURE SEARCHING PROCESS
In this you will need to include the databases used, the key words, any filter options you use such as date, language, country of origin and the number of hits at each stage of the searching process. You also need to identify how you found ‘non-journal’ sources you use such as books, leaflets, policies.
MAIN BODY (please see notes on next page for more information about content).
This section needs to be split into smaller sections based on the topic/subtopic.
Section One: General discussion on chosen main topic.
Section Two: General discussion on subtopic.
Section Three: Focused discussion on how main topic and subtopic are linked and at the end identify themes.
Section Four onwards: Focused discussion on identified themes. Each theme should be addressed separately and linked to the main topic/subtopic when needed.
An example (Pain Management for Surgical Patients – unrelated to this essay) is:
Section One: Pain – what is pain, what happens in the body, types of pain, theories related to pain.
Section Two: Surgery – what happens in surgery to cause pain, what type of pain is it.
Section Three: Post-operative pain – theory about post-operative pain, how long should it last, what happens to patients who are in pain (e.g. lack of mobilising, decreased appetite), reasons why is it important to manage pain effective.
From this you identify important themes for further discussion. Following sections in this example could include pain assessment, nurse knowledge of pain, patient education, pain specialist team, pain management pharmacological, pain management non-pharmacological.
Summarise the main points of the essay. Think about each section you have written about and try and summarise the important bits into one or two sentences and highlight what this means in relation to other points and nursing practice/patient care…………? Introduction:
o Identify the chosen topic, provide a rationale for choice and include the specific content to be covered.
? Describe the literature searching process:
o How you searched for evidence, the search terms you used, the databases you used and how you narrowed down/widened the search. Rationales for all decisions must be given.
? Main Body – Demonstrate an understanding of:
o The chosen topic in relation to the theory you have discovered by presenting a wide and varied range of contemporary literature, including primary research, to support your content.
o The impact of the chosen topic/theory on clinical practice.
o Summarise the content of the assignment.
o Draw together the themes of discussion
The aim of this assignment is to discuss the importance of communication in palliative care. According to Wallace 2001,” effective communication has been describe as a core element in palliative care”. Firstly, the search strategy used to obtain literature will be identified, and will cover search terms and database used with a rationale. Secondly, key terms used within the assignment will briefly be explained, which will include a description of communication in relation to palliative care in a clinical setting. Thirdly, the literature gained will be discussed as to how it imparts on communication in palliative care. As a result, findings will be used to inform practice to deliver a better and effective way of communicating in palliative care. Lastly all knowledge gained will be identified; a summary of the assignment will be given.
Cinahl database is the main primary mode of search engine in finding this primary article. It is used because according to Schneder et al (2008) “selection of appropriate database relates to the purpose and the topic of the search”. They further suggest that, Cinahl uses nursing specific terms that may differ from those used in Medline or other database. Porter (2008) defines Cinahl as cumulative index of nursing and Allied health literature, indexes. He further goes on to say it produced literature pertaining to nursing, allied health consumer health and biomedicine. Palliative care only is keyed and it generated 21819 hits. Palliative care is joined to end of life care by the Boolean phrase “and” and generated 3532. After that, palliative care and end of life care is joined with communication to generate 558 articles. Articles search is further scrutinised by searching for only full text in the 558 articles generated to come out with 132 articles. This is further reduced to 85 articles by selecting Abstracts only in the refine column, Since Academic journals are paramount to the search, Academic journals were ticked in the refine column to reduce the articles to 80. Finally, 55 articles were identified for this core research. In other to maximise this research, books and useful websites were used.
Communication is the exchange of information, emotions and ideas. A message is passed from a source to a receiver and often back again. Without communication it is impossible to make our needs, feelings, desires, individually and opinion know. This type of interaction is essential to physical and mental wellbeing of an individual, as without it we can become isolated and experience negative effects when a variety of needs go unmet (Walsh, 2011). In effective communication, a message is sent from one source to be receive by another, however real communication takes place when the receiver gives a form of response to the sender, (Turner, 1996). According to Daniels (2004), when people communicate they do not only send verbal messages but also through non-verbal actions as well.
Communication as a results can be regarded as either verbal or non-verbal. Verbal communication helps in the development of relationship with patients and nurses and allows the sharing of information about patient care, (stein-Parbury, 2009). Bunker (2008) defines verbal communication as the sharing of information through written and spoken word. Verbal communication is widely used by nurses. Nurses converse with patients and relatives, write care plans, documents information and assessments, and input data into the electronics records. On the other hand, non-verbal communication can be explained as the exchange of information without the use of words, it is what is not said, and that is action. It is one of the most powerful ways people convey message to others, (Bassavanthappa, 2003). According to bunker (2008) message expressed through body posture, gestures, facial expressions and other forms of non-verbal behaviour make available clues or suggestions to a person’s true feelings and beliefs. Moreover Ballas and Baltas (2002) propose that body language was used by individuals earlier than they developed verbal language.
Touch is another aspect of non-verbal communication that can be directed and used in a meaningful manner to offer comfort, emotional interaction and connection, (Chang, 2001). However, patients can be different in their analysis and experience of touch and it can therefore be observed as unsuitable and non-therapeutic for a number of patients, (Routassalo 1999; Sapr et al, 2000). Razavi & Delvaux (1997) suggests that listening is an imperative instruments in aiding health care professionals to assess patient’s problems, requirement and resources. There factors that are perceived as barriers in communication.
A communication barrier is any factors that hinder the achievement of understanding between the sender and receiver, (Cieajy, 2004). Burnard (1997) claims that, it is the aspiration for every person to communicate efficiently; unfortunately, we do not often make out how communication barriers normally have an effect on message distribution. Patterson & Greeny (1990) argued that, language barrier is a critical barrier to effective communication, different accent, language and vocabulary mean nothing or different things to different people. Also, feedback has been another aspect of a communication barrier. Without any feedback, the sender would not know if the recipient understands the intention of the message or if the receiver obtains the message completely (McKay, 2009). The necessity for feedback is extremely helpful because it will further the communication.
Effective communication is significant when caring for patients since, it provides the exchange of information which is required to assess the patient’s health conditions, make decisions on the treatment plans, put into practice the plans and evaluate the effects of treatment on the patient’s quality of life, (Tindall et al, 2012). In nursing, communication is very important because information of health-related information is shared between a patient, patient’s relatives and health care professionals. One of the most fundamental goals of nursing staff is that, their patients experience effective communication whenever they meet to discuss issues surrounding their health (Department of health 2010). Sheldon et al (2006) states that, “effective communication is the cornerstone of the nurse patient relationship” and vital to the good provision of good care to patients in a hospital (Watson, 1998, Mencles et al 1999). According to Nursing and Midwifery Council (2010) “communication is identified as one of the essential skills that students must acquire in order to make progress through their education and training to become a qualified nurse”. Effective communication is very important in caring patients in palliative care.
The World Health Organisation (WHO, 2010) recently redefined palliative care as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identified and impeccable assessment and treatment to pain and other problems, physical, psychological and spiritual”. Matzo & Shennan (2010) states that, palliative care commence at the time when a person is diagnosed with a life threating illness and carries on across the illness course. According to National Institute for Health Care Excellence (NICE, 2004), palliative care is the responsibility of all health and social care professionals delivering care. Every person with life-threatening illness has the right to receive appropriate care wherever they are, (Department of Health, 1998). Researchers have studied the positive effects palliative care have on patients. A current study shows that patients who receives palliative care, report that there is always an improvement in their communication with their health care providers and family members (National Institute of Nursing Research, 2011).
According to Shanoon et al 2011, end of life care has gained strong from healthcare practitioners and health policy makers alike. Communication has been recommended to be one of the key component of good palliative care or end of life practice. Andrew & Taylor (2012) states communication is principal in the delivery of high quality personal care. It is further suggested “that, there is recognition that the communication in relation to life threatening illness and end of life have particular implication in terms of psychological morbidity, effective assessment of needs, information sharing and decision making” (Heaven and Maguire, 2008, cited in Andrew & Taylor, 2012). Fallowfield (2002) carried out a methodical review based on one randomised controlled trial (RCT), which estimated oncologists’ communication skills and two other trials by Razavi (2002), which evaluated nurses’ and communication skills that were principally relevant to the projected assessment, found evidence for improving oncologists and nurses’ communication skills. The first Razavi trial considered the impact of 3 intensive courses taught more than 8 weeks on communication skills in a sample of 72nurses. The second trial measured the impact of a communication skills curriculum on 115 oncology nurses. The Razavi trials made available some evidence of improving nurses’ communication skills, but both trials were based on small samples. Fallowfield discovered in the research that, the course was shown to have a positive effect on nurse’s confidence in dealing with cancer patients. It was also evident that if nurses undertake this mode of communication skills training, patient’s satisfaction with nurses, communication will improve. An important aspect of communication in palliative care is breaking bad news.
The term “breaking bad news” is normally used to give explanation to the instant when patient and/or relative is given negative medical information about their diagnosis, treatment prognosis
(Ptacek et al 2001, Vanderkeift, 2001). Similarly, breaking bad news can also be explained in the health care perspective as giving health related information that ***** changes an individual’s perception or expectation of present or future wellbeing, (Bailey, 2000, Randall & Wearn 2005). Arnold & Egan (2004) state that “the ***compassionately communicate difficult and “bad news” to patient and family is essential*******provision of quality of care at the end of life. However, if bad news is communicated*******cause long lasting distress, confusion and resentment. (Falllowfield). Breaking bad news is a complex and highly skilled activity that needs to be done well to prevent harmful result to patients, their family and their future relationship with healthcare professionals ( Baile et al. 2000, Rossin et al.2006)
A descriptive survey design was design was carried out with a questionnaire to produce a quantitative data to provide information of diversity of issues. One of the questions was the obligation of a nurse in relation to breaking bad news. The people responsible for this study used quantitative research for the reason that they required to discover the responsibility of the nurse in breaking bad news in the inpatient clinical setting and occurrence of their participation in breaking bad news. From the conclusion, it was presumed that the most situation these nurses found themselves giving patients and relative support and opportunities to speak following the moment they had received the bad news. The least incidence was in fact breaking bad news to a patient or relative. The result was based on the frequency of breaking bad news in which partakers had been involved in during the preceding three months. Also, it was figured out that nurses were actually good at breaking bad news because majority of the responses regarding the information given, support and opportunities for patients discuss their illnesses were often the done by nurses. Nurses know their patients and are aware of the right moments they can give bad news and make time for patients and their relatives to talk about implications of the news received.
An increasing body of confirmation has established that most patients wish to be informed on the subject of their illness, treatment and prognosis whether the information is good or bad, (Glass 2004, Hagerty et al, 2005, Cox et al, 2006). However, breaking bad news can also be recognised as a process, one that take accounts of communications that happens before, during and after the instant bad news is given (Tobin and Begley 2008). The act of preparing patients or relatives for bad news, clarifying and explaining the information of their situation become part of the processof breaking bad news (Dewar 2000, Rossin et al, 2006). The supportive activities that nurses have been found to engage in around bad news include assessing needs for information, identifying and clarifying misunderstandings, initiating discussion, obtaining and explaining complex medical information and helping patients and relatives cope with their emotional reactions (Morrissey 1997, Norton & Telerico 200, McSteen & Peden-McAoine 2006, Stayt 2007).
Communication with end of life care can be less than most favourable, leaving patients their families fighting back to acquire the information they require in other to make informed choices, (Schaler, 2005). A qualitative study invented was used to observe communication and decisions about end of life and hospice care. Participants were patients, siblings and children of the departed patients with cancer who had been cared for from 2002-2002 at the University of Maryland Greenbaum Cancer Centre in Baltimore. Although the research was done in the United State of America, qualitative research is used worldwide and the evidence is based on the participants. The writers used a qualitative research method because this survey was to consider how healthcare providers communicate about end-of-life and hospice care with patients who have terminal cancer and how their families handled the information. From the findings it was deduced that this research is in accordance with most studies in which effective communication among families’ patients and healthcare professionals was presented as the main criterion used by family members for assessing the quality of end of life care, (Hanson, Danis & Garrett, 1997, Wenrich et al; 2001, 2003).
Clayton, Butow and Tettershall, (2007) established that, patients and caregivers gave emphasis to the significance of sincerity and regularity of information given to them. It was perceived in this survey that quality of communication that patients and family members had with their health care professionals were more rewarding for duration of life-threatening aliments. Faulkner (1998) states, “relatives may not want patients to be informed of disease progression and may ask nurses to collude with them in this. Although it is often considered that this is based on the carer’s fear and distress, it may also be requested as an act of love and a need to protect”. An example in this instance is a loving spouse may not want the patients told the diagnosis because he or she thinks that the patient since it may then give up hope, and may then die sooner, leaving the spouse to grieve sooner. Despite this, this discussion with patients are very important since it helps them to make their choices and making sure their wishes are well known to their family before they pass on. According to the Nursing and Midwifery Council’s code of conduct (2008), health care professionals are expected to be honest; they should act with integrity and uphold the reputation of their profession. These professionals, are individually answerable for actions and omissions in their practice, and must always be able to justify their decisions. Again, it is the duty of the health care professional to share with people. In a way they can understand, the information they want or need to know about their health. For a patient to be properly cared for there should be a team of health care profession who will work in the interest of the patient.
Interprofessional teamwork is a practice orientation, a method in which health-care professionals work collectively with their patients. It entails the constant communication of two or more professionals, structured into a general attempt, to resolve or discover frequent mailers with best possible contribution of the patient, (Herbelt, 2005). Lugton (2001) explains that, interprofessional communication can improve or hinder psychological support which can be given patient and their relative by the team. Sharing information about patients in palliative care helps health care professionals to know about the phase of the patients illness, what the future holds for them so that appropriate can be considered in their favour. Lo and Snyder (1999) states that “conversation about end of life with patients and families are never easy; however physicians ought to have these dialogues in order to benefit the patient”. Interprofessional cooperation involves paying attention to sharing, partnership, joint working, and power issues (D’Amour et al, 2005). It has been recommended that except professionals communicate well with each other they are likely to be successful in the exchanges of information with patients and carers separately which might end up contradicting each other. Nevertheless a number of nurses have been reported to discover interacting with colleagues more difficult as compared to their patients, (Fallowfield et al, 2001). This may be due to authority differences, position confusion or simple dissimilarity in communication manner and values of care. One important way to resolve these complications nurses to reflect on how they influence communication and from time to time, endeavour to position themselves into their colleague’s shoes and communicate by means of their language (Mullaby 2000). Regular team meetings may also be useful in improving interprofessional communication (Faulkner 1998).
Another common problem in interprofesstional collaboration involves communication that extends further that the role of understanding. Interprofessional collaboration encourages and make possible communication to take place (Shaw et al, 2005) through interaction and the sharing of knowledge. Conversely, if role uncertainty is present, or there is poor understanding of roles, collaboration is compromised (Shaw et al, 2005). Lack of understanding of other professional role and responsibilities influence team communication in what can be a confusing or negative manner (Conner et al, 2008; Demiris et al, 2008). Therefore, among interprofessionals, there should be the awareness of roles, responsibilities, and good communication skills which serves as the basics for effective interprofessional teamwork (Robinson and Cotrell, 2005). Communication skills is recognised as imperative and it consists of networking, interpersonal skills, conflict resolution, management of alteration, and conciliation (Norris et al, 2005). An adverse outcome of ineffective communication can be the rejection of proposed management plan and the potential loss of opportunities to improve the wellbeing of patients, MacDonald (2004).
A research was conducted by Walshe et al (2008) about communication among health care professionals in palliative care. In collecting the data for the research, a subject matter was organised for each interview which was open ended and informal in nature. The Gold Standard Framework (2000) was cited unexpectedly by respondents are an influence on referral practices. This research was not initially regarded as a study of the GSF and this was one of the limitations of this study. The set up was to explore the impacts on referrals within community palliative care services and therefore this may not have totally investigated the aspects of framework that were essential to participants. On the other hand, this can also be considered as strength since most participants were therefore not intentionally selected because of their interest in the GSF and made comments spontaneously bout GSF.
In conclusion, effective communication is essential because it strengthens successful treatment and care and contributes to emotional welfare and patient fulfilment. However, poor communication on the other hand, can undermine trust, broaden misinterpretation and negatively manipulate work fulfilment among healthcare professionals. In palliative care, the work of communication effectively is complex by the understanding that death might be close and require consideration, timing and sympathy. Communication in these situations should transmit the message the patients are secure and cherished individuals (MacDonald, 2004), and both patients and families need to feel that death and dying will be a dignified, comfortable and caring process (Berry 2007).