According to Levett-Jones’ Clinical Reasoning process (2013), before the first home visit, the nurse should go through all the information about the patient, including John’s medical history, the results of previous observations, assessments and exams, current using medications, referral reason and his social situation. This will help the nurse getting the knowledge about John and planning the initial visit.
The most urgent priority for the Initial visit is to assess John’s pain. According to the given information, John is suffering from significant ongoing pain for years and the pain is suddenly increasing. By undertaking pain assessment, the nurse could know the detail about John’s pain as in its intensity, location, onset, duration, variation and quality (Tollefson, 2012). Australian Centre for Evidence Based Aged Care (2012) suggests that untreated pain may cause by the health professional’s inadequate knowledge and lack of effective pain assessment. However, the possible consequence of untreated pain includes physical and psychosocial dysfunction (ACEBAC, 2012). 'Assessment is the first stage in the nursing process and must be the first stage in pain management (Mitchell, 2011, para.13) '. Therefore, a comprehensive pain assessmen...
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...ssion is positive, John could be referred to a psychologist or a mental health facility to have a full professional mental state exam and care.
In conclusion, the priorities for John are reducing his pain, maintain and improving his mobility function, assessing and assisting with his psychosocial function, and assessing his risk of getting depression. Overall, the community nurse tends to improve John’s health-related quality of life. In order to do that, the nurse should have done all kinds of assessments and interventions, and involves healthcare practitioners from multiple disciplines, including physicians, physiotherapists, occupational therapists, GP, psychologists and pharmacists, to participate in the interventions. As pain is a multi-modal experience it should come as no surprise that effective pain management needs a multi-professional approach psychologist.
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