Evaluation Of The Aset Nurse Assessment

Ageing is not something that we can avoid. It is in fact the one thing we can guarantee will happen in our lives, our bodies and minds will slowly age. Though as technology advances along with the sciences and skills needed to assist the aged we see the current rise in a populous of people living longer and healthier lives. Medical change is happening currently, this involves the way we not only medically treat us clients but how we approach their ageing processes through person centered care, communications and strength-based nursing. Health professionals within the multidisciplinary team try more now the ever before to include the client and their family in the decision-making process of how the client will receive care. This has changed dramatically from the past as the client has little input in the individualized care they received by medical personnel. This paper will critically assess a video in which an ASET nurse, also known as Aged Services Emergency Team, performs a short assessment on an elderly gentleman named Max.

The role of an ASET nurse is to assess Aboriginal and Torres Strait Islanders over the age of 50 and all others over 70 years of age, in identifying their physical, psychological and social needs that will prevent or minimize future readmissions to hospital. Person-centered communication with an older person During the ageing process, there are changes that occur in the whole mind and body systems that can affect the way clients communicate. These changes of concern in this discussion is those associated with communication. As Max has identified in the discussion he has difficulty in communication. Max has identified to the ASET nurse that he currently is provided with aids to use to assist with his hearing deficit but currently does not correctly apply or wear the provided aids, due to clarity and effectiveness of sound. Although Max seems to appear not to have difficulties communicating effectively during the video, it is important to recognize that he is in a quiet, enclosed environment, where hearing may not be an issue with the ASET nurse in that instance and that in a social, or louder environment hearing may differ, causing Max to be uncommunicative. T

he ASET nurse utilized a skill called ‘person centered communication’ (Svha.org.au, 2018) to try and build a rapport with Max. During the video the ASET nurse questioned Max about his cat and if it was a good cat or an attack cat. The ASET nurse has chosen this strategy to use humor and light heartedness to build a rapport with Max. This line of direct questioning was a great way of using a person centered communicative approach. It has been found that “Client centered communication is a critical component in creating and sustaining and shared partnership through words and actions.

After the initial rapport building with Max, the ASET nurse has notably let the rapport and person-cent red communication flow to fall short and the rapport that the ASET nurse had built loses all conscious effort to continue with the current way of person center approach with Max. This is due to the seemingly unorganized approach that the conversation follows when the nurse went on to ask questions in an unorganized manner and at times answering her own questions for Max, therefore Max has no clear chance to answer for himself. An example of this is when the nurse asks Max if he drinks alcohol, Max states “Yes”, to which the ASET nurse replies, “So how many would you have a night, 3 or 4”? One of the principles of person centered care is communication. Person centered communication is involving the client and their family in the effective organization of the quality and quantity of care for the client and achievable outcome for their medical treatment from the multidisciplinary team.

During the interview with Max and the ASET nurse the principle of communication is missed due to the ASET nurse not including Max’s family and wife. The missed chance of using the communication skill to involve Max and family, do not allow the ASET nurse to gather enough personal and medical information to correctly assess and write a detailed history for Max and his care planning goals, Currently the ASET nurse is unable to deliver information and education to Max about preventing hospital visits, including age related issues, The ASET nurse does not incorporate Max’s wife’s health status, only that she is currently employed as a nurse.

Physical functioning

There are a range of exams that will assess the physical functionality of a person, they range in type and form. During the interview the ASET nurse follows her own structured plan for Max, we see this as the interview continues. The ASET nurse questions Max about his hearing, sight, oral health, mobility and ability to complete activities of daily living, Max’s response to these questions could give the ASET nurse the impression there is no concerns with physical functioning. However, Max did state earlier during the interview that he requires the use of hearing aids but does not use them. Opening the opportunity for education regarding hearing loss, benefits of aids and who to contact to ensure aids are being used correctly, however the nurse did not take the opportunity to give that information to Max instead ceasing that part of the conversation. Again, this is a missed opportunity for the ASET nurse as this information is important as Max has already stated that along with his hearing deficit he also currently suffers from depression.

Psychological functioning

During the interview the ASET nurse has asked Max about his mood, Max’s response to the direct question was to state that he is depressed, and he has self-diagnosed this. Max states that his moods come and go and usually take care of themselves. After this statement the ASET nurse responds in kind with “Your Gp has a good handle on it” implying that Max is currently being treated and managed for his depression by his treating doctor. Max responds that he has mentioned it to his doctor, though does not correct the assumption made by the ASET nurse that it is being correctly managed. The ASET nurse does not gather a history of Max’s current treatment or diagnosis of his depression. Max has again given the ASET nurse an opportunity to explore Max’s current mental status, educate and support Max’s needs. Max would benefit from a mini mental exam.

Social functioning

Max states that he currently lives with his wife, though he states he “is not very social’. When further prompted by the ASET nurse, Max elaborates on the answer by stating that he likes to work with wood and doing activities by himself around the home. Max is not currently socially isolated, though it is unknown if Max chooses to isolate himself from social interactions. A social inventory tool could help gage Max’s reasoning for isolating himself. The CHSD has developed several screening tools that prompt assessment, referral and broader needs identification. These tools have been implemented in a series of projects, beginning with functional screening and assessment in Home and Community Care and Aged Care Programs. At the national level, these tools are known as the Australian Community Care Needs Assessment (ACCNA) and the Carer Eligibility and Needs Assessment (CENA).

Strength based assessment

Strength based assessment is a tool that focuses on people’s strengths rather than their problems, with an aim to move away from categorizing the person as the problem and to focus on their strengths and resilience by empowering the client to be the problem solver, essentially giving the client and families some power and control in their own care. In accordance with one of the principals the nurse considered Max’s personal environment, by inquiring who Max lives with, who is responsible for basic housework, maintenance and activities of daily living. The ASET nurse questioned and acquired information regarding Max’s health and healing however did not give any education, information or assistance with areas of concern, particularly mental health, hearing aids, regular alcohol consumption and the link to falls risk. The ASET nurse stated, “many older people do not take their medications correctly and gave statistics by stating that 98% of people leave their hearing aid in their bedside draw”. She also appropriately explained to Max how to get out of an arm chair safely, which is beneficial.

Conclusion

The ASET nurse undertook her assessment in a professional way and met many of the principals outlined in the ASET guidelines, creating a rapport and gave some information and education that was beneficial under learning and self-determination. The ASET nurse has during the interview missed many opportunities to assist Max with the principals of strength-based nursing and person-centered care highlighting the inclusion of the person in their choice of care.