1. The term ‘holistic’ refers to a philosophy of nursing practice that considers all aspects of patient care, considering the physical, emotional, social, economic and spiritual needs of patient/clients/service users. Within primary care all members of the nursing team will make an holistic assessment. Gathering of information and the formulation of judgements regarding a person’s health, situation, needs and wishes which should guide further action (DOH, 2000). It is the first stage in the nursing process. References Student number 09050418 ‘The gathering of information and the formulation of judgments regarding a person's health, situation, needs & wishes, which should guide further action.’ (DoH, 2000) The holistic nurse/HCSW is an instrument of healing and a facilitator in the healing process. Holistic nurses/HCSW honour each individual's subjective experience about health, health beliefs, and values. To ‘undertake and document a comprehensive systematic and accurate nursing assessment of the physical, psychological, social and spiritual needs of the patients, clients and communities.’ (DoH, 2000) The nurse/HCSW needs to be able to provide a nursing diagnoses to identify the patient’s needs. To ensure that the services meet the needs of the patient and to avoid risks to independence. To also develop goals and outcomes and to develop care plans. It’s about collecting appropriate information or data about a person, his/her carer and family. This could be :- objective.. Involving blood pressure or subjective.. based on a professional’s feelings, values & beliefs. All patients and clients have a right to receive information about their condition. You must always respect a patient’s autonomy. No-one has the right to give consent on behalf of another competent adult. You must treat information about patient’s and clients as confidential and use it only for the purpose for which it was given. You should seek patient and client wishes regarding the sharing of information with their family and others. (NMC, 2008) Family Carers Healthcare Assistants Student Nurses Qualified Nurses Nurse Specialist's Doctors Observe Touch Listen Smell Use equipment to record vital signs:- temperature, blood pressure, pulse, respirations Assessment Tools Breathing effort Skin colour Size of patient Swelling Distress Rashes General body language Sputum Urine faeces Pulse Temperature Sweating Clamminess Pain Sensation Swelling Coherence Communication ability Noise of breathing History of events Ask questions in the correct way (be diplomatic, specific, phrase questions to provide yes or no answers if the patient is unable to speak clearly. Patient hygiene standards should be assessed. Urinary tract infections maybe evident A smell of ketones could indicate a patient who is starved or a patient with diabetic ketoacidosis Sputum Wounds The developing role of the Healthcare Support Worker (HCSW) is now widely recognised and considered a fundamental part of the NHS Modernisation Agenda (Wanless, 2003; Wag, 2005; WAG, 2010), in order to increase flexibility and capacity and improve efficiency and effectiveness by making best use of staff resources and skills (Spilsbury et al, 2011). Assessing and caring for people holistically has now become part of the appropriately trained HCSW’s role in general practice. Appropriate delegation and understanding one’s own accountability are critical to taking on this developing role. The Code of Conduct for HCSW in Wales (WAG, 2011) and the All Wales Guidelines for Delegation (WAG, 2010) clearly set out the standards that are to be achieved in order that high quality, safe and effective care is delivered by HCSWs. Setting the Direction (WAG, 2010) is a community based strategy that advocates a paradigm shift from hospital to community based care in Wales. Holistic care and assessment involving HCSW’s in the primary care setting, will enhance the patient experience by working in partnership with patients and families to identify and address their holistic health and social care needs, whilst encouraging and supporting independence (WAG, 2005). Department of Health (2000) Nurse, midwives and health visitors (training) Amendment Rules approved order 2000. Stationary office. London NMC (2008) Code of Professional Conduct: standards for conduct performance and ethics. http://www.rcn.org.uk/__data/assets/pdf_file/0008/361907/Accountability_HCA_leaflet_A5_ final.pdf. Welsh Assembly Government (2005) Making the Connections Designed for Life: Creating World Class Health and Social Care for Wales in the 21 st Century. Cardiff, Welsh Assembly Government. Wanless D (2003) Securing our Future Health: Taking a Long- Term View. The Final Report. London: Department of Health. Welsh Assembly Government (2010) Setting the Direction: Primary and Community Strategic Delivery Programme. Cardiff, Welsh Assembly Government. Welsh Assembly Government (2011) Code of Conduct for Healthcare Support Workers in Wales. Cardiff, Welsh Assembly Government. Spilsbury, K., Adamson, J., Atkin, K., Bartlett, C., Bloor, K., Borglin, G, Carr-Hill, R., McGaughan, D., McKenna, H., Stuttard, L, Wakefield, A (2011) Evaluation of the Development and Impact of Assistant Paractitioners Supporting the Work of Ward-Based Registered Nurses in Acute NHS (Hospital) Trusts in England. Final Report. NIHR Service Delivery and Organisation Programme. http://www.rcn.org.uk/__data/assets/pdf_file/0008/361907/Accountability_HCA_leaflet_A5_ final.pdf According to (WAG, 2010) failure to or inconsistent approaches to delegation can have a negative impact on the quality of care and the culture of the work environment. Delegation is not new and is practiced every day in a range of work environments. Delegation is often undertaken as a sub-conscious function. Its purpose is to ensure: Service users receive timely and appropriate care. Staff resources are utilised effectively, work is shared fairly. HCSW feel valued and motivated, which can achieve team success. It can also be positive to make sure the HCSW is trained and thinking and working more holistically for the best care possible for the patient. (RCN, 2010) state that all health care teams include a range of registered professionals, health care assistants (HCAs), assistant practitioners (APs) and students. It is vital that each member of the team is clear about their level of accountability and that the registered staff are confident when delegating tasks to their colleagues. That every member of the team is trained appropriate before providing holistic care to the patient.