WORD COUNT 4399
The assignment will discuss a critical incident from a nursing management perspective, being an admission assessment experienced during placement. It is not a care study. There will be an overview of the nurse-managers responsibilities during the admission assessment and attention drawn to local and government policy. Particular consideration is given to risk assessment, Essence of Care (DoH 2001) in respect of the Waterlow Pressure Damage Assessment (1985), pressure sores, nutritional screening and delegation. Other issues considered will be communication, partnership working, the therapeutic relationship, and the nurse as an agent of change. Findings will be supported by literature. Identifying factors have been changed to respect patient confidentiality.

Mary had no previous psychiatric history. She was eighty-four and lived in residential accommodation. She had two adult daughters who were unable to attend Mary’s admission. Prior to admission Mary’s behaviour had changed over several weeks and she had been refusing to get out of bed during the day. During admission she showed occasional signs of confusion but was able to give consent. Physically, Mary was in a wheelchair, had a history of falls, pressure damage, skin flaps. and needed full assistance with mobility. My mentor facilitated her admission assessment. I observed this in preparation of undertaking future ones myself whilst under supervision.

From a management perspective my mentor who was the senior nurse needed to consider who would be left on the ward whilst he and I did the admission. He needed to consider risk management issues and ensure that there would be a safe and effective level of staffing and skills mix to care for the other patients on the ward and to deal with the daily ward issues. (Risk Management Strategy LPT 2003)

Care pathways concentrate on the management