On a female only respiratory ward in the West Midlands a patient was admitted to the ward with chest pain and shortness of breath. Her name was withheld in order to conform with patient confidentiality (Dimond, 2002). Due to being registered deaf, the patient had difficulty com
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municating verbally. She had a form of Aphasia resulting in stuttering.
A friend of the family asked if the nurses could note down the procedures for the patient. The friend proceeded to use British Sign Language (BSL) to pass on information when trying to converse with the patient. The BSL use several movements which include hand gestures, lip patterns, fingerspelling and facial expression (National Health Services choices, 2013).
The tissue viability (TV) nurses advised daily leg dressings for ulcerated legs and her personal care and medication were organised. She was kept informed by written notes. All NHS Policies, Procedures and The Code of Conduct within the Trust were followed as protocol. The patient began to refuse any care. It is the right of a mentally competent person to refuse treatment (Dimond, 2005, p142).
After several attempts to change nurses, the patient still refused. This was
done to see if she was more comfortable with one particular nurse. The patient was unable to sleep through the night. The nursing team followed person centred care. The nurses began trying to reason with her to give her consent for treatment.
At this time the patient could have been lying in her own urine and faeces. If her leg was not attended to, further complications could occur. Her leg could become gangrenous and need operating on. All healthcare professionals want to adhere to safeguarding the patient. The Care Quality Commission (CQC) (2014) states “safeguarding means protecting people’s health, wellbeing and human rights, and enabling them to live free from harm, abuse and neglect. It is fundamental to creating high-quality health and social care”. The nurses wanted to respect and think of the dignity of the patient.
Eventually the patient allowed her observations, blood sugar levels and a urine analyses to be done. A urine sample is dipped using a “multiple combination strips – e.g., five tests on each strip (detects blood, ketones, glucose, pH and protein), or seven tests on each strip (tests for blood, ketones, glucose, pH, bilirubin, urobilinogen and protein)” (Henderson, 2004). The sample was sent to microbiology to be investigated into more for underling infection that could be causing her behaviour. At all times information was provided for the patient to make her own decisions and to use all communication sources in place.
Manley et al (RCN) (2011) “Healthcare teams, healthcare provider organisations and governments often articulate an intention to deliver person-centred care. However, achieving it is often challenging and difficult to sustain”. HHHh
This section aims to highlight Holistic and Person-Centred care with reference to the scenario. The paper will look at professional issues in nursing practice, and it is linked with ethical issues. It will then address the importance of effective communication skills. It is including the trust’s policies and procedures, The Royal Marsden hand book, Nursing
Midwifery Council, The Royal College Nursing and Department of Health.
To be able to plan appropriate nursing care the whole of the patient needs to be assessed, physically, medically and psychologically. This is Holistic assessment. All aspects of the patient’s lifestyle, age, gender and how they are feeling needs to be obtained. Whilst the nurse is doing the assessment they must use all of their senses. Therapeutic communication, hearing, visual and touching should be used (Smith, 2012, pp.5-7).
The Health Foundation (2014) states that ‘Person-Centred Care show an important way to make the patient feel involved in their own care’. If the patient has control over their own body and mind, then they will have an understanding of what is happening to them. Person-centred care is in place for the patients, staff and families all to get involved in the planning, care and discharge. It involves compassion which is important in a nurse’s role as the patient enters unfamiliar territory. All staff needs to consider the patients respect and dignity is upheld, with closing curtains, covering up the patient and asking for consent to enter the patient’s bed space.
Person-Centred Care was followed in the scenario. The Doctor and the nurses asked for the family to come in to discuss the care of the patient. The nurses communicated with a friend of the family because the patient’s partner also had a hearing impediment. Then they communicated with the patient and told her it was in her best interest if she allowed the staff to care for her.
The leg began to weep through the dressing. It was over due to be changed. She still refused help. The student nurse who was helping the patient seemed to have a positive impact on her. Price (2006, p.50) states that the person centred care approach needs different frameworks to accommodate different patients. Making sure to look at the patient as an individual. This is what the student nurse did. The patient believed she had previously met with the student nurse.
The patient refused to co-operate with other nurses. The patient was very
co-operative with the student nurse. The student nurse began basic sign language in order to communicate. Then the patient responded, and allowed other staff to look after her. Eventually the patient co-operated, the test results were all fine, and Doctors were not concerned.
Professional issues in nursing practice are linked with ethical issues. In the dictionary the definition of “professional” states “Worthy of or appropriate to a professional person; competent, skilful, or assured” (Oxford 2014). A nurse needs to be professional in their everyday role in work and in their personal life. The Code of Professional Conduct informs a patient what standard should be expected from a registered practitioner. (Burnard. and Chapman, 2004, p1). A competent and caring nurse.
The student nurse noticed the patient was struggling to communicate and had difficulty with other nurses. The student nurse thought she would be professional and use her signing skills to help with communicating.
According to Tschudin (1986) in (Burnard. and Chapman, 2004, p6). Claims that “ethics is caring” and that “to act ethically is to care…to care for ourselves and others”. The healthcare profession can not bring in their own ethics into the hospital; they may have certain religious or moral ideas. On the other hand the patient’s family may have ethical issues. The ethical issues of her understanding what was happening was taken into account by all communication sources in place for her to be in control of her own body and to give her consent.
Medical staff needs to use effective communication with family or friends. They need to be their advocate, to help them to communicate. Active listening is a skill which is also needed to communicate. Look at body language and what the patient is saying. The speed one speaks has to be thought about and the tone. If as much information is given to nurses and doctors as possible then it all helps in the care process. Therefore, communicating with the patient’s friend helped the medical team to understand the health of patient before admittance.
Family are encouraged to stay with the patients, to keep them company and bring in their own belongings to reduce the anxiety of being in strange surroundings. “Good communication helps to build a therapeutic relationship”(Collins, 2009).A nurse is often the one to explain to the patient what a doctor has just said, in a more simple way, to listen to any problems.
All the policy and procedures that are in place at the hospital were followed. One particular policy that was followed is from the hospital hand book of leg ulcer management (2013). This ensures that her leg had been graded, reported and recorded. There had been photographs taken of the leg. Then the leg dressed with all the correct dressings for the grade and type of wound. The Tissue Viability nurses had been to check the wound then advised the nurses what was required to put on the area for healing. The patient was treated as seemed fit by her condition, making sure the antiseptic technique was used.
It is necessary to use knowledge to provide a person and family centred care in The Royal Marsden Hospital Manual of Clinical Nursing Procedures it states that “Poor communication with patients can negatively affect decision making and quality of life” (Dougherty, L and Lister, S (Eds) 2011; Fallowfield et al 2001; Thorne et al 2005,p198). It is not always possible to communicate face to face or to be seen or heard. Perhaps a gentle hand on the shoulder would help. In the case of a deaf person to make sure to stand in a good light so lips can be read. After all a patient has been taken out of their own surroundings and put onto a ward, in a strange bed with strange people around them. A nurse needs to find ways to help the patient to know what is being done without being frightened.
The Nursing Midwifery Council (NMC) is a governing body. The NMC, (2012) states that they have a “vision, mission and values”. Its vision is to make sure nurses and midwives always give their best healthcare to safe guard the public. Their mission is to maintain a register of nurses and midwives making sure they are fit to practice. The education of nurses fits the correct standard. If these are not adhered to then they are dealt with. The
values are for those who need services of nurses and midwifes, they act in the best interest and are open and transparent in their actions and take responsibility. They show consideration and understanding and act with integrity. Also work to high standards and are experts in what they do. Modern health is used and works in partnership with others and provides equality (NMC, 2012, p.3).
The hospital guidelines are “Vision, Values and Strategic Goals”. “They place their patients at the centre of all they do”, “work together to deliver top quality services” and “try to be innovative how they work and create an environment for people to thrive in”(The Royal Wolverhampton, 2014). The student nurse tried to deliver quality service by trying to use her skill in the small amount of sign language she knew.
The Royal College Nursing (2012) state that the “people in your care must be treated as individuals and their dignity must be respected”. The medical team have to reach a certain level and to behave in a certain way. After the entire patient’s life is in their hands. The professional issue of the case is the delivery of care given to the patient was followed to the care plan in place everything was taken into consideration. The Department of Health states that “People who use health and care services have the right to be treated with respect, dignity and compassion by staff who have the skills and time to care for them” (DOH, 2013).
The patient was treated with a high standard of care and alternatives to help with her communication needs were implemented. At a later stage the patient would be discharged from the hospital and transferred under the guide of Community Care Matron. The patient would need to be assessed in order to identify the specific care required. Conclution
From a nursing persective it was evident that a good quality of Person- Centred- Care was implemented. It was taken into account that there were more complicated matters than the patient’s ulcerated leg. The staff worked well as a team, this showed in the way the nurses tried to alternate their care. Everyone worked with the professionalism that beholds a
nurse,competent,skilful and assured. They worked effectively with the communication needs that were in their power to do so. Note taking and using the family and friend for help when signing.The communication problem caused by the patient’s deafness could have been made easer if all staff were trained in BSL. This training must be put in place to allow patient and staff to have better communication.
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