With the continuous progression of healthcare, the implementation of patient-centred diagnosis has become an essential element in the provision of outstanding care. This approach is dedicated to customising the diagnostic journey according to the distinct needs, values, and preferences of each individual, establishing nurses as an indispensable part of the diagnostic collective. Nurses, frequently serving as the initial point of engagement for patients, are vital in certifying that diagnoses are not only clinically accurate but also compassionately attuned to the wider circumstances of the patient’s life. This article will examine the varied roles that nurses undertake in patient-centred diagnosis, emphasising their significant role in assessment, communication, and advocacy. Such endeavors are instrumental in shaping a healthcare environment where patients are not just participants but are also deeply understood and valued.
1. Shared Decision Making for Diagnosis
Patient-centred diagnosis is best practiced through shared decision making. This approach involves an iterative dialogue between doctors, nurses, and patients. It respects a patient’s needs, values, preferences, and circumstances. Unlike treatment decisions, diagnostic decisions require a different approach.
2. Beyond Information Exchange
Shared decision making goes beyond simple information exchange. It emphasises collaboration and deliberation between patients, family, and clinicians. The goal is to advance the desired outcomes identified by the patient. Here’s a conceptual model of patient-centered diagnosis:
Patient-Centred Diagnosis
In this model:
Clinical context includes the presenting patient concern, the clinician’s role, and the clinical setting.
A dialogue between clinician and patient (and/or family) is used to agree on a patient-centred diagnostic plan.
Deliberation covers patient preferences that are global, such as the patient’s capacity and overall goals of care.
3. The Nurse’s Critical Role
Nurses play a pivotal role in the diagnostic process. Despite being underrecognized, they contribute significantly by:
Ensuring effective communication with patients & family.
Coordinating care.
Providing patient education.
Monitoring a patient’s condition.
Identifying and preventing potential diagnostic errors.
Prescribing medication
Exploring language and cultural barriers
Maintaining a focus on life, palliative care, end of life care, and death education
4. Case Study: Acute Pyelonephritis and Dementia
Let’s explore a case study on acute pyelonephritis and dementia. Effective history taking and refined physical examination skills are powerful tools for excluding differential diagnoses. Nurses, with their close patient interactions, are essential partners in achieving accurate diagnoses.
Diagnosing Acute Pyelonephritis involves approaches where nurses play a crucial role. Here are the key components that a nurse may be involved in when diagnosing this condition:
Effective History Taking: Gathering a comprehensive history is vital. Nurses often collect details about the patient’s symptoms, medical history, and any recent events that could have contributed to the condition.
Physical Examination Skills: Nurses perform physical examinations to identify signs consistent with Acute Pyelonephritis, such as flank pain, fever, and nausea.
Assessment of Urinary Symptoms: Nurses assess urinary symptoms that may include dysuria, polyuria, frequency, and urgency. Changes in urine odour and colour can also indicate bacteriuria.
Monitoring Laboratory Tests: Nurses monitor laboratory test results, including urinalysis and blood tests, which can provide evidence of infection and inflammation.
Patient Education: Nurses educate patients about their condition, treatment options, and preventive measures to avoid recurrence.
Administering Medications: If within their scope of practice, nurses may administer antibiotics and other medications as prescribed by a physician.
Evaluating Patient Response: Nurses continually assess the patient’s response to treatment and adjust care plans accordingly.
The diagnosis of Dementia is a complex process that typically includes several crucial steps, such as obtaining a detailed collateral history, conducting psychometric assessments, performing brain imaging scans and relevant routine blood test. These components enable healthcare professionals to gain an in-depth understanding of a person's cognitive abilities and exclude other possible reasons for their symptoms.
Collateral History: A detailed history from someone who knows the patient well is crucial. It helps to establish the extent of cognitive decline and its impact on daily functioning.
Psychometric Battery: Cognitive tests assess various aspects of brain function, including memory, language, problem-solving, and attention.
Brain Scans: Imaging tests like CT, MRI, SPECT scans can detect changes in brain structure and cerebral blood flow that may indicate dementia and help differentiate between types of dementia.
Routine Blood Test: Liver function: To rule out liver diseases which can affect cognitive abilities. Kidney function: Impaired kidney function can lead to an accumulation of toxins which can affect mental processes. Thyroid function: Both hyperthyroidism and hypothyroidism can cause cognitive issues. HbA1c: To check for diabetes, as poorly controlled diabetes can lead to cognitive decline. Vitamin B12 and folate levels: Deficiencies can cause neurological symptom
These elements, along with a physical examination and laboratory tests, form a comprehensive approach to diagnosing dementia. The list is not exhaustive. Additional considerations should include: diagnostic uncertainty (to aid in making informed decisions), risk-benefit analysis (evaluating the risks and benefits of treatments), patient/family education (comprehension of the condition, diagnostic process, and implications of findings), interdisciplinary collaboration (to obtain diverse perspectives and expertise), ethical considerations (upholding the patient's autonomy and confidentiality throughout the process), cultural competence (addressing sensitive, cultural issues and barriers) and post diagnostic support (information, community connection, practical support, emotional/psychological wellbeing). It is crucial to recognise that while these aspects are commonly employed, the diagnostic procedure may differ based on the individual case and available resources. Throughout the entire process, nurses play a crucial role in maintaining patient safety as a primary concern. Their role includes a broad spectrum of responsibilities.
Conclusion
The pivotal role of nurses in diverse healthcare sectors is highlighted by their responsibilities, which ensure that care delivered to patients and their families is not only comprehensive and empathetic but also addresses their holistic wellbeing. Central to patient-centred diagnosis, nurses leverage their clinical acumen and a collaborative approach to decision-making. This synergy with patients and fellow healthcare practitioners fosters improved health outcomes and patient satisfaction. Nurses’ invaluable contributions are the linchpin of precise diagnostic processes and effective care coordination, guaranteeing prompt and suitable treatment for patients. In essence, each nurse’s involvement enriches the diagnostic process, steering healthcare towards a more patient-focused and inclusive direction.
Note: As an independent nurse working in the community, I have the opportunity to make a significant impact on patient care and their family. A close collaboration with colleagues allows for a more integrated approach to healthcare, ensuring that patients receive comprehensive and continuous care tailored to their needs. This community-based model of care is essential for promoting health, preventing illness, and managing long-term conditions. A valuable position to be in.
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