Project Basic Patient Care Essay Paper

Project Basic Patient Care Essay Paper

In the third year of my nurse training, I was placed in a local hospice. Following undertaking in house training; which included infection control, it was highlighted that there had be an increased infection rate within the hospice. I noticed how the presentation incorporated the importance of hand hygiene however it did not demonstrate the correct hand washing procedure. For the purpose of the assignment, I was explore my personal and professional development through explaining how carrying out a practice placement project has impacted on my learning and development. Hamill (1999) recommends writing in first person when referring to your own experiences, I feel this highlights personal and professional qualities and allows us to reflect and analyse on our own development.Project Basic Patient Care Essay Paper

The flexible learning module includes attending university one day a week to plan and discuss learning needs and assessments. Race (1998) describes flexible learning as “Putting the student at the centre of the learning process, enabling some control around how and when you will study, undertaking activities as an individual or with contact with a lecturer, and continuing to facilitate your own learning. Therefore, once a week, we were allocated time to attend action learning sets in the university.Communication, in healthcare, is a multidimensional concept that involves patients, family members, and a health care team. There is a direct correlation with communication, improving a patient’s well being, and quality of care. Adequate communication among physicians and their patients is an actively growing research topic. Results supplied by such studies have provided effective recommendations for oncologists and their team. These recommendations include the patient-physician relationship, how physicians utilize medical information, how physicians deal with patient emotions, physician self-management, and educational conferences designed to sharpen communication.

 

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Modern day Healthcare has increasingly embraced concepts of client-centred practice and empowerment. However, Taylor (2003) posits that existing literature on the subject does not give clear and unambiguous descriptions of the ways by which nurses can empower clients. Nonetheless, nursing practice is inclusive of people from very different backgrounds. In my ward for example, a high proportion of the nurses did not get their initial qualifications and experience in the UK, and my mentor too did not start of as a nurse from the UK. As a result of this, in the absence of well defined guidance for patient empowerment as a practice concept (by regulatory authorities), nurses and other healthcare practitioners will always encounter difficulties in the performance of their duties – in recognition of patient empowerment as a concept.Project Basic Patient Care Essay Paper

The way patient care is manifest in hospitals has evolved over time and now centres around collaborative working with different teams coming together to ensure that client care and outcomes are improved (Hansson et al 2008), (Hewison and Stanton 2003). Working in this way requires that the patient is an inclusive and active partner in his care planning and care delivery. This new way of working has also been emphasised by the government introducing the agenda for patient-centred care and patient empowerment. The Department of Health stipulates that the NHS needs to empower patients more and give them control over their healthcare (DoH 2008) and the World Health Organisation (WHO) also requires that patients are always consulted before any procedure is carried out on them (WHO website). The whole concept of empowering patients may not be new to healthcare practitioners because some healthcare practitioners are known to have spoken about making efforts to carry the clients along in the process of their care delivery (Stewart et al. 2002), but Paterson (2001) claims that some healthcare professionals have also been known to use subtle and covert ways to avoid fully implementing the patient empowerment requirement even at the risk of going against regulation to empower patients. Empowerment has been (in essence) practitioner defined to suit the practitioners. As an example, at the MDT meetings I attended, the patients’ views were not adequately promoted, and considering the requirements of the patient empowerment agenda, the patient is supposed be in charge of his healthcare.

I raised this with my mentor and the ward manager, and recommended that the patient be consulted before, and updated after every meeting that has to do with his care delivery. Acknowledging client empowerment as a way forward and in emphasising the need for this modern way of working, the Prime Minister in a key message in January 2008 said that patients are to be treated as active partners in their care. Brown et al (2006) consider that for care to be client-centred, care delivery must be focused on the client and empower and engage the client to his/her full potential as a partner in his/her care delivery. Whereas the client-centred concept requires that what is best for the patient is done, patient empowerment requires providing clients with adequate information and the knowledge required to make informed decisions and take control of their lives (Kielhofner 2002). The issue of patient empowerment raises an issue about empowering intellectually disabled persons who cannot make such decisions on their own. If an adult with intellectual disability does not have complete ability to communicate, their choices can be diminished which in turn can make it particularly difficult to ensure that their opinions are heard (Cameron and Murphy 2002); and even in instances where a nurse is designated the health facilitator for the client, there is no guidance as to how much decision making can be undertaken on his behalf (Martin and Carey 2009). These further complicate issues in nursing management for a qualified nurse and will call on good managerial skills. Modern healthcare practice environment is a highly regulated one with stringent requirements of the healthcare practitioners. The continued drive for improvement in both healthcare delivery service and the patient’s experience and quality of life (DoH 2005) have led to the promotion of improved integration between healthcare disciplines and agencies, and regulatory requirements to promote the concept of patient empowerment (DoH 2008), (Corsello and Tinkelman 2008), (Glasby and Parker 2008). Empowerment is a natural phenomenon and is essential to humans.Project Basic Patient Care Essay Paper

Patient empowerment may be resisted by nurses because of existing nurse-patient relationships (Nyatanga and Dann 2002) and so a deliberate cultural shift needs to be pursued to inculcate nurses with the shift in paradigm. To achieve, the nurse will need additional training, and the clients ought to be carried along in drawing up treatment plans. The more the client is involved in the treatment planning, the more the client appreciates his/her part in the patient empowerment agenda, and the more the satisfaction with the care delivery service. I have used simple courtesies like saying ‘thank you’ to the client, and realised it brightens their day very much and also makes them much happier and willing to discuss their feelings and opinions with me. The convergence of management and nursing has evolved over the past few decades and management is often cited as the reason for failings, and also as the likely solution (Pollitt 1993) to many of the problems in the NHS. Management was first formally defined by Henry Fayol (1949) as the composite function of planning, organizing, coordinating, commanding and controlling activities or events. More recent definitions in management theory look at management from the perspective of empowerment, total quality management, organizational culture etc. (Hewison and Stanton 2003). Leadership and management skills in nursing overlap to a very large extent but whereas leadership skills are needed in the more personal aspects like mentoring and motivation, management skills are needed to meet organizational targets and the management of available resources.

With the problems associated with recruitment and retention of nurses in the health sector, and the attendant high turnover of nurses came an additional expectation of nurse-managers to help reverse the trend (even though several of the pioneering nurse-managers had not had formal managerial training) (Contino 2004). Contino (2004) described the managerial skills required of a good nurse manager to include change management, communicating plans, managing the flow of information, managing nursing ROTAs and managing finances (income and expenses). Courtney et al (2002) rate financial management knowledge as one of the top requirements for a nurse manager in order to understand financial forecasts, financial plans, financial ratios and financial performance ratios. A nurse manager needs to be very conversant with current practices and concepts. A good understanding of service improvement and knowledge (and use) of the available developmental resources for nurse improvement like the Leadership at Point of Care programme (Janes and Mullan 2007) are essential for successful nurse-management.Project Basic Patient Care Essay Paper

The following three areas chosen that as a student nurse will be discussing in this essay are: Confidentiality, Accuracy of Information and Working in Partnership. Some examples will be given to explain and underpin some of the concepts that will be explained later in the assay.

What is a Person centred care?

Starting with what (Ponte et al, 2003) state that the Person Centred Care (PCC) is the consideration of the patient’s point of view and taking into account their decision on meeting their goals.

How people try to define it?

Unfortunately there is not a definite definition, but as a student nurse, the understanding of the person-centred care is when the Health Care Profession put the patient at the centre of the whole process, give the possibility to have the best treatment regarding their illness, give them the choice to receive the treatments, respect their decision making and keep all the information confidential.

One of the areas very important for the PCC is Confidentiality.

(Department of Health 2003), saying that

responsibility of confidentiality occurs when one person releases information to another, for example to a multidisciplinary team, this is happen in situation where it is reasonable to expect that the information will be held in confidence.

As the definition suggests, confidentiality is the key to form a trusted relationship between patients and Health Care Profession.

There are some exceptions to this duty.

Sometime it is allowed or even obligatory to violate a patient’s confidentiality, for example when a patient suffers from a notifiable illness. (Mcferrant, 2008).

Information has to be shared or disclosed to other health care professionals to provide the best solution of treatment for the patient with their permission. This is done because the patient can receive care from different member of the team.

Unfortunately is no always easy to obtain consent from the patient; because for mental health issues or because is under age to give consent, however it is important that the patient or his family understand that some data have to be disclosed around the medical team.

How confidentiality relates to the two Principals A and D?

Confidentiality is the centre of connection (relationship) between the health care providers and the patient, allowing an honest and open line of communication between the two parties; also it helps in the understanding needs and how to proceed with their treatments.Project Basic Patient Care Essay Paper

Confidentiality means privacy, means dignity and there are important aspects of our personal life and when a patient is admitted to hospital the staffs take very seriously this element of care.

To keep the patient’s information confidential is quite challenging and is very much influenced by the ward arrangement and available space. In particular when the discussion takes place behind the curtains or at the bedside, may result in breaches of confidentiality. We all are aware where to discuss patient information.

The key priority is guarding the dignity and the confidentiality of the patient using coded curtains pegs or signs.

Another significant element of PCC is accuracy of information, because without it, the patient cannot receive the correct treatment and medication.

Every person that comes to hospital has to be assessed by the professional staff, to ensure that the best quality care is given to the patient. This is reviewed as minimum every week or as frequently as the condition require. When all these information are correct and updated all the time we can say that the delivery of the quality care is effective and safe.

Also when a patient is transferred from one ward to another the notes and the debriefing have to be done in a correct way to avoid mistake.

For example, at the end of every shift, the hand over is given to the relative nurses with the relevant information regarding each patient on her bay. To keep the patient save, the NHS’s system assigned a unique number together with date of birth and names, to identify each person correctly, making sure that the right patient get the correct medication and the medical records are recorded and tracked correctly.

As a student nurse is very important to learn how to write and keep written records in order and updated, detailed about the care and treatment provided and for future plans. The clinical notes also contains x-rays, photographs and anything can be use to support treatments. These are to be kept accurate, secure and confidential. It is a good practice according to the NMC (Nursing Midwifery Council) to keep valuable data, to maintain high standard of clinical care, good communication and also help to notice any changes in the patient’s condition.

The practice of nursing is a dynamic and evolving profession. Engaging and negotiate with the patient has shown to be effective in achieving cooperation in result of more participation in the therapy to accomplish specific goals.

As a student nurse we are part of a wider health care team that includes: assistant practitioner, health care assistant and nurses, we are accountable for good record keeping. All these information which includes all different forms regarding care and treatments, must be accurate, use simple terminology (for the patient to understand), no abbreviations should be used, signed, timed, and dated if are handwritten to provide support in communication and decision making.

There are keys principals that must be followed to keep the records clear and effective.Project Basic Patient Care Essay Paper

These are produced by the Royal College of Nursing (RCN).

For example if some information have been omitted in the patient’s notes, regarding the administration of medication, and another medical staff will give another dose of the same medication, this will result in overdose the patient and consequence make the patient ill even more and breach the duty of care.

The PCC involved working in partnership.

Lyotard (1992) argue that since the new national schemes has been created, the social problems such as poor housing and poverty have increased rather than diminished.

Health care professionals and Social Services have been pushed to involve more the consumers in their decision making regarding their services rather than passively received them. The current policy highlights a three-way partnership between health, social care providers and services users, in which determine the combination of services that must be provided and by whom, with join services to break down barriers and responding to the local requirements.

Working successful in partnership is one of the keys to improve Person centred-care treatments.

Families, friends, doctors and health care professionals are called together to put in place an optimum plan to best interest of the patient. Involving the patients’ families contribute to expand the knowledge about that specific patient, to know more about their routine and their personality.

(Joint Improvement Team 2009) defined that working in partnership consist in two or more independent professional, working together to accomplish more successful results, than they could by working independently with the willing to share their achievements and failures.

Multidisciplinary team is formed by several different qualified professional who are involved in diverse areas of expertise, that are able to coordinate and response to patients needs.

Working in partnership means plan a method to support individuals, allowing them to take charge and meet their goals, also guide them to have a better quality life in every aspect form good mental health to physical disabilities.

For example: if we have a good relationship with a patient there will be a possibility that he/she will open himself to you and tell you about the abused received from the family or from the Home he is living. In any of this case we have a duty to report the abuse to the ward manager or is in charge and the relevant profession team will be call in to intervene and put a plane together to protect the patient.

The Healthcare Quality Strategy for NHS Scotland (Scottish Government 2010) was a further development from ‘Better Health, Better Care’ (Scottish Government 2007). In this reflective account I wish to concentrate on the peoples priorities for the people of Scotland outlined within this document, the ultimate aim is to provide the highest quality of care. It has as their objectives that care given should be consistent, person centered, clinically effective and safe and equitable with patients receiving clear communication with regards to conditions and treatment (Scottish Government 2010). Hubley and Copeman, (2008) state communication skills are paramount in healthcare to ensure that tailored advice is delivered effectively.Project Basic Patient Care Essay Paper

 

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This reflective account is based on an experience from my 3rd year management placement. Using Gibbs’s Reflective Model (1988) I aim to outline what occurred throughout the incident which involved providing clear communication and patient centered care and how this can be linked to the Quality Strategy in relation to the people’s priorities. This reflective model has been selected as it enables reflection on practice in a structured way allowing one to identify critical learning and development from their experience to enhance future practice (Bullman and Schutz, 2008). This scenario will consider how this incident will aid in my transition from student nurse to staff nurse.

To comply with patients’ rights to confidentiality and in accordance with the Nursing and Midwifery Council (NMC), (2010) I will use the pseudonym Mrs Wade.

DESCRIPTION

This reflection involves a 78 year old lady Mrs Wade who was an inpatient on the ward for 10 days after being diagnosed as having a cerebral haemorrhage. This had left Mrs Wade with a left sided weakness and aphasic. It was during afternoon visiting and taking the routine observations I noted Mrs Wade to be scoring one on the National Early Warning Score chart (NEWS) due to reduced oxygen saturation levels of 95%. However, on comparing this with previous readings this was within the parameters of her levels taken over the previous days. . I had just moved on to the next patient when Mrs Wade’s son who was visiting asked me to come back as his mother was indicating that she had pain in her chest radiating to her left jaw. I immediately took another set of observations and Mrs Wade was now scoring 10 on the NEWS chart. I immediately went to seek guidance from my mentor who instructed me to show my findings to the doctor whilst she administered GTN spray. The doctor came and assessed Mrs Wade and instructed me to administer 5mg of morphine, 15 liters of oxygen and commence an initial 250ml bag of normal saline and if Mrs Wades BP had still not risen I was to continue with a second bag, whilst he arranged an ECG and chest X-ray.Project Basic Patient Care Essay Paper

At this time my mentor advised me that I was to take control of the situation and she would assist me if I required help.

FEELINGS

My initial feeling was one of complete fear. However, I felt within seconds I regained my composure and I took control of the situation. I was relieved that training had indeed prepared me for a situation like this where I automatically began to use the ABCDE assessment (Jevon, 2010). I was also anxious but relieved in being able to communicate effectively with the doctor, my mentor, team members and Mrs Wades son. I felt I was able to handover clearly and concisely. I feel that I was able to do this as I had been dealing with Mrs Wade on each of my days on duty over the previous two weeks.

EVALUATION

The negative aspect from this incident is how a patient in one’s care can deteriorate so rapidly. However, in the case of Mrs Wade I repeatedly asked myself if I had missed some signs and this incident could have been avoided.

The positive aspect of this incident was that Mrs Wade’s deterioration had been caught instantly. I had the opportunity to discuss this incident with my mentor. At this time she praised me on how I had taken control of the situation in a calm and professional manner. I was competent when communicating with team explaining the background to Mrs Wade’s condition thus aiding an effective result in Mrs Wade’s condition being stabilized. It was also reiterated that this was an unavoidable situation and there was nothing I could have done differently to alter the outcome.Project Basic Patient Care Essay Paper

ANALYSIS

The people’s priorities outlined by The Healthcare Quality Strategy for NHS Scotland (Scottish Government 2010) and in caring for Mrs Wade on reflection I wanted to be establishing if I covered all areas and were I could improve. The priorities are to be caring and compassionate, have clear communication skills and be able to explain conditions and treatment have effective collaboration between clinicians, patients and others; A clean and safe care environment; Continuity of care; and Clinical excellence.

Jones (2012) advocates that it is essential in nursing to have good communication skills. This is also advocated by Dougherty and Lister (2008) who states that communication is an integral part of maintaining a high quality of record keeping which is regarded as a vital standard of practice by the NMC (2008). Communication and written care records aid to establish a continuity of care.

As I found Mrs Wade to have deteriorated it is stated by Hill (2012) that the outcome for a deteriorating patient is dependent on the knowledge and skills of the person or persons who find and care for them and the recognition of the acutely ill. As I was the first responder and having called for help I used my mentor and other team members to assist myself in assessing and stabilizing Mrs Wades vital signs. At this time I also asked my colleague to ensure Mrs Wades son was taken to the day room and someone would come to speak with him as soon as possible. This is fundamental to patient centered-care to communicate openly and honestly with all concerned (Brooker and Nicol, 2008).

I used ABCDE approach recommended by Jevons (2010) and The Resuscitation Council (2010). The ABCDE approach is a systematic tool were by you assess your patient and deal with the life threatening situations first. During this time I endeavored to reassure Mrs Wade at all times through effective communication skills (Scottish Government 2010, p6). Although Mrs Wade was aphasic her airways were patent and no obstruction was noted. Therefore it was acceptable to move on to B (breathing) within the ABCDE. Patients presenting with Myocardial Infarction (MI) or Pulmonary Embolism can show an increased respiratory rate. As Mrs Wade’s respiratory rate had increased and was desaturating she was commenced on high flow oxygen (O’Driscoll 2008).Project Basic Patient Care Essay Paper

Mrs Wades heart rate 109 beats per minute and on palpating the radial pulse it was fast but strong and regular. Mrs Wade’s blood pressure had decreased to 89/56 therefore commenced on a 250ml bag of saline. Urine output was already being monitored and IV access was in place.

The next stage is Disability. AVPU is a tool used to assess levels of consciousness within acutely ill patients (Jevon 2009b). This is a quick assessment tool within the NEWS and ABCDE approach; However, NICE 2007 recommend the use of the Glasgow Coma Scale to give a full assessment. At this stage my mentor checked blood glucose levels. Blood glucose levels can rise in acutely ill patients due to a result of sympathetic activation (Floras 2009). However at this stage they were within the normal range of 4-7mmol/L (Diabetes UK 2013).

During this situation to communicate my findings I used a systematic approach based on situation, background, assessment and recommendation (SBAR) tool to share the necessary information effectively and concisely (Pope et al 2009).

In the emergency situation with Mrs Wade this highlights the involvement of nurses in collaboration with other healthcare professionals and coordinate all resources to provided effective timely care. I feel that I took on the role as lead nurse in this situation I knew it was my responsibility as a student nurse in my final placement to show that I could take control of this situation, whilst in the knowledge knowing I still had my mentor if I felt I required assistance. I felt I had to show I could effectively delegate, show leadership qualities, prioritise the care of Mrs Wade whilst being able to communicate effectively in a challenging situation.

The outcome was positive in the aspect that a holistic approach to Mrs Wade’s condition was taken in accordance with The Scottish Government’s Initiative (2010) on patient centered care. I felt empowered by incorporating the use of the SBAR framework in effective collaboration with the multidisciplinary team aided clear communicating in accordance with The Scottish Government (2010). This resulted in a consistent continuity of care for Mrs Wade.Project Basic Patient Care Essay Paper

ACTION PLAN

A result of this significant event was that it gave me the experience of dealing with an emergency situation. As stated by Scheffer and Rubenfeld (2000) “Critical thinking in nursing is an essential component of professional accountability and quality nursing care. Critical thinkers in nursing exhibit these habits of the mind: confidence, contextual perspective, creativity, flexibility, inquisitiveness, intellectual integrity, intuition, open-mindedness, perseverance, and reflection. Critical thinkers in nursing practice the cognitive skills of analyzing, applying standards, discriminating, information seeking, logical reasoning, predicting, and transforming knowledge”. I was also given the opportunity afterwards to reflect on my role and the role each member of the team took in this situation and where appropriate to remove oneself from a situation

I feel for future development I will take responsibility for my own learning in areas where I felt I lacked knowledge. In this situation I had assumed that Mrs Wade was having an MI were in fact it was a PE. I believe that in the future and with more experience I may be able to differentiate and although I would not expect to be an expert I would be better equipped to deal with similar situations in the future (RCN 2013). I was particularly anxious as I know I have no experience in Basic Life Support other than what I had learned at university and knowing this woman was for resuscitation I was anxious that this situation may occur.Project Basic Patient Care Essay Paper

OVERALL CONCLUSION

On reflection of my own experience and in using this to aid in my transition from student nurse to staff nurse I feel I have enhanced my own knowledge on basic life support outlined by the British Resuscitation Council UK (2010) cited by (Dougherty and Lister, 2011) whilst reiterating the importance of good communication skills. It also highlighted the importance of having the confidence to acknowledge one’s own lack of knowledge and be able to admit to this and where to seek guidance to ensure that the correct protocol is followed to ensure patient safety at all times and to provide continuity of care. I feel that the care given to this patient is in line with the initiative of The Scottish Government’s Healthcare Quality Strategy for Scotland (2010).

In relation to how this incident reflects on my transition it shows that on graduating as a staff nurse I will immediately assume the role which includes leadership, delegation and supervision. Once NMC registered, a host of expectations are placed upon you. The RCN (2010) reported that newly qualified staff nurses feel unprepared and overwhelmed by their new responsibilities, making the period of transition very stressful rather than exciting and truly enjoyable. However, I hope to overcome these feelings by immersing myself in the knowledge that I will adhere to all policies and guideline by The Scottish Government (2010) to ensure the best possible care and service to all.

Carney (2009) reported that clients were more likely to be dissatisfied whenever they felt the nurse leader was incompetent. The Nursing and Midwifery Council (NMC) requires that the nurse is conversant with and aware of current developments in practice by way of continued professional development after qualifying as a trained nurse. To manage a team well, a nurse will need very good communication skills in addition to the authority to take decisions within the boundaries of his/her responsibility (Cross and Prusak 2002), (Carroll 2005) as and when necessary. A nurse manager should be a good team-player and able to multi-task (Jaynelle and Stichler 2006) and possess very good communication skills that go beyond language and/or grammar, to listening, being assertive and ensuring that the nurse’s decisions are enforced especially when the nurse speaks on behalf of a client (or helps to amplify the clients voice) (Harris 2003).Project Basic Patient Care Essay Paper

The nurse manager should ensure that adequate communication links are established between the client and the MDT so that client views are always considered. The nurse manager should patiently try to clearly understand the patient (Lynden 2006) so as to be able to ensure client’s views are accommodated in client’s care delivery. In situations of acute ailments, clients can present with intellectual disability or a moderated ability to communicate verbally which can make it difficult to understand their opinions or wishes (Cameron and Murphy 2002) for their care process. To be a leader, today’s nurse will need to be able to command the respect of other team members. To achieve acceptability nurse managers need to be people with high integrity and people management/motivation skills and be able to work in a collaborative setting (Carroll 2005). Integrity in this perspective is synonymous with honesty (Kouzes and Posner 2002) and several studies have highlighted the importance of honesty for nurse management or leadership because people (clients and nurses alike) will want to assure themselves that their leader is worthy of their trust (Kouzes and Posner 2003). During my placements in an adult care unit of a major hospital, from observation and interaction with patients and healthcare staff, my attention was drawn to a plight of some of the patients in my care: I realised that some of the patients were not being allowed to determine the course of their treatment as required by the patient empowerment agenda (DoH 2008) and this was more especial in patients with acute ailments.

There was a lack of full management implementation of the Patient empowerment agenda, with particular emphasis on the relevance given to the patient’s choice (or voice) in the patient’s care delivery. The quality of care delivery is assessed by its ability to improve patient care through the collaborative team work of healthcare professionals and how patient-focused the care delivery is. For the purposes of this work, I shall refer to a renal patient in my care during my placement as Mr. B (not real name). All references to him or a hospital do not identify either. When Mr. B was … and was refusing to be compliant, I approached him and had a talk with him. I discovered that his lack of compliance was in protest of the fact that he was not aware he was being put on … reinforcing the position of Corsello and Tinkelman (2008) that clients will respond better to care that encourages their participation and is considerate of their specific needs. To ensure that this did not happen again, I brought the patient’s complaint to the attention of my mentor and ensured that the multi-disciplinary team was made aware by adequately documenting my findings and observations. I regularly sought advice and guidance from my mentor because mentoring and role-modeling are active ways of knowledge transfer in large organizations (Carney 2009) and improves the care delivery service. Service improvement remains a core requirement for the Knowledge and Skills Framework for a registered nurse (DoH 2004) and requires an all-party embracing culture of seeking continuous improvement (Janes and Mullan 2007) where honest and periodic performance appraisals are evident.Project Basic Patient Care Essay Paper

Service improvement in the NHS has been an issue of high importance and has necessitated the establishment of groups that are charged with charting out improvements within the NHS – like the ‘NHS Improvement’ (NHS Improvement Programme 2008). Practicing nurses are encouraged to keep abreast with developments from such groups. A new service improvement concept of ‘patient-safety’ is gaining popularity in healthcare although regulatory definition is not yet specific (Feng et al 2008). Flin and Yule (2003) claim patients can be injured through the actions of healthcare staff, and Feng et al (2008) insist that a blame and shame culture inhibits learning from mistakes and can exacerbate incidences of mistakes. To this end (in the UK) an Expert group was established that recommended that the culture around error reporting shifted towards finding the cause of the error rather than the culprit (DoH 2000). Nurses are often under pressure from shortage of nursing staff, and a change in the nursing environment can improve patient safety and outcomes (Lin and Liang 2007). During my placements, I observed that Mr. B was often in bed for prolonged periods between nursing visits. I appraised the risk of the situation and ranked his needs by priority. He looked like he was beginning to get sore from immobility, so I delegated his need for exercise to the physiotherapist in the MDT, and having assessed the competency level of the HCA on the ward, I delegated the tasks of keeping Mr. B’s environment clean and regularly turning him to air his back to the HCA. The HCA had been previously supervised for this task and had been assessed as competent to perform it satisfactorily.

This is a reflective essay that will be focusing on my experience and feeling on how I related with a patient who was complaining of severe pain in the surgical ward during my posting there. I will be using the Gibbs (1998) reflective cycle as a guide on this essay. The Gibbs (1998) Reflective Cycle which is one of the most popular models of reflections consists of six steps: Description which describes as a matter of fact the situation and what happened during the incident. For my case the management of this patient who was admitted and was being managed pre-operatively for intestinal obstruction; secondly, feelings which is the description or the analysis of what my thoughts and feeling were at the time of this incident. Thirdly, the evaluation of my experience: this is about what was good and bad about my experience. Fourthly the analysis of my experience about what I can make out of the situation. Conclusion is the sixth step and it is about what else I could have done and what could I not have done. The final step is the action plan. The action plan will be about what I will do if this situation arose again or what I will do differently bearing in mind my experience from the steps above (Jasper 2003).Project Basic Patient Care Essay Paper

Reflective practice writing is a way of expressing and explaining one’s own and others stories crafting and shaping to and understanding and development and it enables practice development because the outcomes of reflection are taken back into practice, improving and developing (Bolton 2005). Reflection “is a way of learning from your direct experiences, rather than from the second-hand experiences of others” (Cottrel 2003, p6). There are several other models of reflective practice. In addition to the Gibbs (1998) models, there are the Johns’ model of reflection (1995); Kolb’s Learning Cycle (1984) and the Atkins and Murphy’s model of reflection (1994).

Description
During my placement at the acute surgical ward, I came across a patient who I will name Mr Jones (not real name). This is due to confidentiality. According to the NMC (2008) The Code: Standards of conduct, performance and ethics for nurses and midwives article 5, 6 and 7, it states that ” You must respect people’s right to confidentiality; You must ensure people are informed about how and why information is shared by those who will be providing their care; You must disclose information if you believe someone may be at risk of harm, in line with the law of the country in which you are practising” (NMC 2008, p2). When I arrived at the ward on the 8th of October, the senior nurse briefed us about the cases on the ward. I learnt that Mr Jones was admitted into the surgical ward with severe abdominal pain and he has been diagnosed with small intestinal obstruction and is being managed pre-operative for surgical intervention. While attending to the patients in the ward under the supervision of my mentor (NMC 2008), Mr Jones called out to me that he is in severe pain. Walking up to him, I noticed the agony and pain he was in. Once he had my attention he was screaming and berating me that he is in terrible pain and that he need more pain killers. I approached Mr Jones and introduced myself with the aim of building an initial and good rapport with him and to establish a nurse-patient relationship (Holland et al 2008). I was so petrified with the signs and the way he communicated with me in such a way that really expressed he was in severe pain. I assured Mr Jones that I will have a word with a qualified nurse and will be back. I walked up to my mentor and ask that Mr Jones would need some pain killers as he is in severe pain.Project Basic Patient Care Essay Paper

I was very surprise when my mentor said to me “okay, where is Mr Jones drug chart”? And to my utmost surprise, instead of getting a cocktail of pain killers for Mr Jones, she was asking several questions. How do you know that he is in such severe pain as you have just described to me? Have you asked him with the trust policy of pain scale? What type of pain killers has been given to Mr Jones and for how long ago were these given to him? She went on and on and I felt embarrassed and at same time very eager to correct my mistakes. I was unable to answer any of the questions she has asked. I guess I must have been overwhelmed with sympathy rather than empathy for the patient. I went to bring Mr Jones’ drug chart and my mentor explained to me that from his drug chart recordings, he is on oral morphine 10mg 4 hourly and the last dosage was given in just an hour ago. He would need a doctor to review to see whether he might need another route and dosage of the analgesic she explain to me.

Feeling
My first feeling was that this patient could be in severe pain and there is need to administer some form of strong analgesics. Pain according to the International Association for the Study of Pain is, “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (IASP 1979). Pain may not be totally objective but subjective according to Braun et al (2003), they went on to further point out that included in pain are emotional as well as personal experiences. Pain could be divided simply into acute and chronic pain based on its duration (Shipton 1999). Acute pain is of short or limited duration usually associated with traumatic tissue injuries, whereas chronic pain is a pain or discomfort persisting for about 3 to 6 months and may persist beyond the healing period (Sinatra et al 2009; Ready and Edwards, 1992) and pain could progress from acute to chronic (Blyth et al, 2003). There is a psychological aspect to pain. According to Eccleston (2001), pain can be influenced among other things by culture, previous pain experience, mood, ability to cope or even belief. He concluded that pain is multifactorial and as such individuals should be treated differently. One of the underpinning principles of the Roper-Logan-Tierney model of nursing is the individualisation of nursing care and nursing practice (Roper et al 2000). My mentor showed me that Mr Jones is on 10mg oral morphine four hourly and that he may need a new review by the doctor so as to reassess his pain. I went to inform Mr Jones of this. On getting to him, I introduced myself with the aim of continuing our initial good rapport and also to obtain consent. According to the RCN “Informed consent is an ongoing agreement by a person to receive treatment, undergo procedures or participate in research, after risks, benefits and alternatives have been adequately explained to them” (RCN 2005, p5). Also, it has long been documented that information reduces anxiety (Byshee 1988 cited in Hughes 2005). I informed him that he will need a reassessment by the doctor in order to change his pain killer or if there is need to increase the dose and that the doctor has been notified of this. To my surprise, this seemed to calm him down a little as I explained and listened empathically to him. In a study carried out by Matthewson at the elderly care unit at New Cross Hospital in Wolverhampton, she concluded that nursing is the art of caring and as such we must listen empathically to what patients and service users want so we can give them the care that they deserve (Matthewson 2002).Project Basic Patient Care Essay Paper

Evaluation
This being my first encounter of meeting a patient with acute pain, I have so much to learn and gain especially about acute pain management. Having ask several questions and establish a good patient-nurse relationship (Holland et al 2008), I was involved in most of management of Mr Jones. Monitoring vital signs and recording them accurately. I learnt according to Mr Jones past medical history that he was first admitted in to the hospital in September 2009 for hernia repair and discharged home. He is now being treated for small intestinal obstruction which is one of the side effects of adhesions which could result from hernia repair (Ryan et al 2004). I asked the qualified nurse series of question and she informed me that caring for patients with intestinal obstruction require great deal of nursing skills. Patients suffering from small intestinal obstruction do have not only physical needs but also psychological and nurses should be aware of the fact that patients react differently to the fact that they are acutely ill (Hughes 2005). The ward sister informed me that some of the important factors to look out for when managing a patient with bowel obstruction are the presentation symptoms and vital signs such as pain, dehydration and fluid and electrolyte imbalance and nausea and vomiting. According to Anderson (2003) vital signs need to be monitored closely for changes by nurses and respond quickly and appropriately.

 

 

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After re-assessment by the resident doctor that responded to the summon, Mr Jones morphine was increased to 20mg, 4 hourly in titrated doses so as to minimize the effect of euphoria and unwanted effects. Also the route of administration was changed so as to quicken the onset of action. According to McQuay and Moore (1999) it is sometimes advisable to change the route of administration if the patient is still complaining of pain as oral and trans-dermal route may delay the onset in acute pain. All strong opioids require careful titration from an expert practitioner it is better to begin with a small dose and increase gradually in conjunction with careful assessment of its effectiveness (Hanks et al 2001).Project Basic Patient Care Essay Paper

Analysis
Despite the fact that Mr Jones has had a surgery to repair his hernia a year earlier and is about to undergo another one shortly, he was in very good spirit. The whole process from when I came into the ward and Mr Jones called out to me that he is in severe pain till now has all been eventful and educating at same time. Mr Jones was given morphine to manage his acute pain. Several preparations are available in the pre-operative period for pain management. These include intramuscular analgesics and opiates such as morphine (Hughes 2005). Morphine was used as a drug of choice in the management of Mr Jones acute pre operative pain. Though it has several advantages that are well suited for small intestinal obstruction management like its effect on slowing down the motility of the gut (Rodney 2010) which in the case of small intestinal obstruction is good, it causes nausea and vomiting as some of its side effect due to its direct action and stimulation of the chemoreceptor trigger zone of the brain (Daniels 2008). Though anti-emetics were prescribed to counter the effect of nausea and vomiting, their effect was not profound and this caused some delay in the operative process.

Under the supervision of my mentor, I actively participated in the monitoring of Mr Jones vital signs. In addition to recording the temperature, I was involved in the monitoring of the fluid and electrolyte balance. Fluid balance was monitored hourly as one of the senior sisters explain to me the importance of a maintaining its balance. Haemodynamic stability is crucial as hypovolaemia can occur quickly because of the obstruction, fluid levels can rise quickly due to decreased gut movement causing the bowel to distend and losing its functionality of absorbing water and minerals thereby leading to fluid and electrolyte imbalance (Torrance and Serginson 2004).Project Basic Patient Care Essay Paper

I feel that the whole process involved in the management of Mr Jones pre-operative acute pain went smoothly. Being my first placement in the surgical ward I asked several questions and mentor and senior nurses were on hand to explain and in some instances demonstrate this out. But what else could I have done or what could I have done differently? Well, from the first time I went to meet the patient and then relaying the patient concern to my mentor, I should have looked at the patient’s drug chart rather than being overwhelmed by self pity. All documentation with regard to the patients’ management is on the patients’ record and it is vital that I look at this. Effectual documentation according to Porter and Perry (2009) within a patient’s medical record is an imperative and fundamental aspect in the practice of nursing. To minimize the risk of errors in the management of a patient, there is the need for accurate documentation of all drug activities in the patients drug chart (Youm 2002). As I have come to realize, pain may not be totally objective but subjective and included in this are elements of emotion as well as personal experience (Braun et al 2003). Rating scale are the most commonly used method of accessing acute pain and its relief. The World Health Organisation (WHO 1996) modified analgesic ladder to control pain in that the simple principle is that the beginning of pharmacological intervention begins on the first step of the ladder and proceeds upward. Opioids are used extensively in the management of pain and believed capable of relieving severe pain more effectively than non steroid anti-inflammatory drugs (NSAIDs) (McQuay and Moore 1999).Project Basic Patient Care Essay Paper

Action Plan
My action plan should a situation such as this arose again will be significantly different. I will continue to reflect and study how acute pain is managed and the role of the nurse in such management and most especially to ensure I look at documentation for patients. Effective pain management is fundamental to quality care, good pain control speeds recovery. To increase the effectiveness of nursing interventions and to improve the management of pain, the use of pain assessment tools for acute pain has to be followed such as verbal description scales(VDS) which are based on numerically ranked words such as none mild, moderate severe and very severe for assessing both pain intensity and response to analgesia. Numerical Rating Scales (NRS) this is easily used as a verbal scale of 0-10 indicating no pain on one extremity of the line and 10 indicating severe pain at the other extremity (Hammer and Davies 1998). Uncontrolled pain can lead to increased anxiety, fear, sleeplessness and muscle tension which further exacerbate pain (Dougherty and Lister (2008). Perkins and Kehlet (2000) suggested that poorly controlled acute pain may lead to the development of chronic pain. I also learnt that there is a psychological aspect to pain. My nurse-patient relationship really helped in this area. According to Holland et al (2008) each patient should be regarded as unique in a nurse-patient relationship and that individuality should be taken into account when undertaking nursing care (Holland et al 2008 p11). Another aspect of nursing care that helped was effective communication which is an essential prerequisite for effective nurse-patient relationship (Robinson 2002). By talking to patient in an open, honest way about their pain made them feel more relaxed and in control which help them to cope better. I hope to increase my nurse-patient relationship and how to deal with acute cases. This will be a goal I will be aiming at in my next placement though discussion with my mentor and further research.

Action learning is described as a continuous process of learning and reflection, supported by colleagues, with an intention of getting things done. (McGill and Beatty 2001) It involves working together to learn, focusing on real problems and reflecting on experiences. The first action learning set involved discussions and ideas with colleagues supported by the facilitator. It was identified in our action learning set the need to focus on the two formative assessments, as part of the flexible learning module.Project Basic Patient Care Essay Paper

Following the first action learning set, my impressions were that I was uncertain that this method of learning would meet my learning needs as I found it difficult to understand how this concept would work with people choosing different topics for their projects. I also found it difficult to communicate, as I didn’t feel confident in talking in groups. Subsequently, we all discussed our ideas and set ourselves actions for the following week. Therefore, by the end of the session I had identified my actions were explore research around the topic of preventing health care associated infections and discuss with my mentor what the practice placement project involved and to make a decision on the topic.

After collating evidence I established that, hand hygiene is regarded as the most effective way of preventing healthcare associated infection’s (Gould 2010). Healthcare associated infections are infections acquired in hospitals or as a result of healthcare interventions (DOH 2008). I felt that this is an important factor in contributing to the prevention and control of infection as Health care associated infections affects patients and their. I feel to provide the best possible care, it is important to within your role, assess and minimise the risks, acting to protect people in your care (NMC 2008).Project Basic Patient Care Essay Paper

During my initial meeting with my mentor, we highlighted my learning needs and personal goals I wished to achieve during the placement. The NMC (2008) states that mentor are professionally accountable for students on placement and have a duty to help students develop nursing competencies. Therefore we explored ideas for the project and following completion of my action, I produced the evidence to my mentor. After discussing my rational for choice I was able to make the decision for the practice placement project. I explained that I didn’t feel confident in speaking in groups and that I was anxious about the presentation. I felt a professional relationship had been built were I was in a position to discuss my thought and feeling and felt I was fully supported by my mentor.

Learning opportunities were provided which included a spoke placement with the infection control nurse. Pellet (2006) states that the role of the mentor in clinical teaching is to facilitate learning experiences. During my spoke placement I had the opportunity to gain information on local and government policy in relation to infection control and was advised on how I could obtain the policies and infection control bacteraemia figures used in the original presentation which highlighted the increase. In the next action learning set I was able to share this information and create new actions to develop and increase my knowledge.

I found out that the hospice devised a policy on infection control however it linked with the local trust and followed their policy and procedure in regards to infection control. Therefore, in order to collate the policies and bacteraemia figures I was advised to contact the infection control nurse at the local trust by telephone. The information I requested was then e-mailed to me. The policy provided me with relevant evidence to use within the presentation; therefore I had developed my evidence base to support my presentation.Project Basic Patient Care Essay Paper

The evidence included government and local policy. The National Patient Safety Agency (NPSA) launched the campaign “clean hands safe care” in 2006 which highlighted the need the effective hand hygiene and identified area for improvement. The World Health Organisation (2010) defines clean hands lead to safer health care.

I decided that in order to produce the project I needed to explore information on learning styles, learning environments and how to create a PowerPoint presentation.

I noticed how the hospices presentation incorporated the importance of hand hygiene however it did not demonstrate the hand washing procedures. Therefore, my action was to research and identify my own learning style developing an understanding of how the audience will respond and learn from the presentation.

Kolb (1984) developed a learning theory which identifies four learning styles. The model provides individuals to understand their learning styles from experience to reflection observation. Kolb (1985) states that it is important for individuals to understand their learning styles, this then allow them to improve their effectiveness as learners. Honey and Mumford (1986, 1992) developed a variation on Kolb’s model and devised their learning styles questionnaire. The four learning styles included activist, reflector, theorist and pragmatist.

The Honey and Mumford questionnaire was discussed in our action learning set and was set as a group action to complete the questionnaire. On completion of the questionnaire, I identified that was a reflection. Honey and Mumford (1992) describe a reflector as observers of experiences, who prefer to analyse them thoroughly before taking action. They are good listeners, cautious and tend to adopt a low profile. Following this description I can relate to this as my initial thoughts of the action learning sets were that I didn’t feel confident talking within a group, therefore I tend to adopt a low profile.Project Basic Patient Care Essay Paper

A demographic questionnaire and Honey and Mumford’s (2000) learning styles questionnaire were administered to a sample of undergraduate nursing student. The results included a trend of reflector as a preferred learning style for undergraduate nurses. This information is also highlighted in previous studies (Alonso 1992, Cavanagh et al 1994 cited in Rasool et al 2007) Analysing the evidence provided me with a knowledge base which enabled me to understand the concept of learning styles, this contributed to my learning and development as I was able to utilise the information to focus on the how I would present the project to meet individuals different learning styles.

After I had completed the proposed actions from the previous action learning set I was able to return and present my findings to the group. The action learning sets provided a point of contact with other and enabled us to share information we had gathered and provided an opportunity to ask questions and set actions to continue with the task. As I had previously identified, according to Honey and Mumford my preferred learning style was a reflector. This enabled me to reflect on my initial thoughts around action learning and emphasised that I do tend to adopt a low profile in situations however following observing and analysing the situation I tend to take action.

Attending a study skills session on database searching within the university was a positive learning experience. I was able to learn new skills in order to development personally, which consequently provides professional development. I decided that utilising the resources within the clinical environment and the university I would continue to practise literature searching to increase and widen my knowledge of the topic and specifically the learning environment. Therefore, this contributed to my next action.

Hand (2006) states that the learning is affected by the environment where it takes place. This article highlighted key factors in promoting effective teaching focusing on characteristics of a good learning environment, the role of the practice placement and demonstrated the awareness of the role of the teacher. This enabled me to incorporate evidence based practise into my project presentation. The NMC (2008) states you must use evidence based practise to provide the best care, it also states the need for taking part in appropriate learning to ensure you develop your competencies. This links with the rationale of choice for my project presentation as the NMC (2008) states the need to provide a high standard and care at all times, delivering care on the best available evidence. Therefore the NPSA “clean your hands” campaign provides clear evidence based practise between hand hygiene and infection control.Project Basic Patient Care Essay Paper

Throughout the placement I had several opportunities to discuss with my mentor the project presentation. Gray and Smith (2000) state that the mentor’s qualities provide an important part of the learning environment and I was able to be supported by being set goals and facilitate my own learning. I had developed my practise placement project using a variety of different resources such as literature searching, clinical experiences, action learning sets. The information I located enabled me to link theory to practise to develop a PowerPoint presentation which incorporated audio and visual effects, as a result ensuring a variety of the audiences learning styles were able to be met. Utilising the evidence I had obtained I was able to provide an evidence based presentation to facilitate learning and development for myself and others in the clinical area. I have learned a lot from this experience from both personal development of preparing and presenting a presentation, enabling me to personally reflect, to reviewing evidence based literature applying this and using it for educational purposes within the clinical environment. This fulfilled my aim and rationale to highlight the importance of hand hygiene and demonstrate the correct procedures. Therefore, having a direct impact on patient care.

Although I had previously expressed anxiety due to not being confident in speaking in groups, the action learning sets along with my mentor had impacted on my development in confidence. Stuart (2007) describes how placements can be stressful and Moscaritolo (2009) states how increased anxiety can reduce learning. However, the delivery of the presentation was successful.Project Basic Patient Care Essay Paper

Pellatt (2006) states the mentors and responsible for the assessment of the students learning in practice. Throughout the placement the mentor provided opportunities were provide constructive feedback, Bennett (2003) states that assessment ensures the student is aware of strengths and weaknesses in practise, this is important so that the student is able enhance their practise. To ensure I received feedback on my presentation I devised a short questionnaire about the presentation and was able to reflect on the feed back I received.

As I have identified throughout this learning experience, I feel I still need to build my confidence. Westwood (2010) states that people are more likely to achieve their goals if they focus on the future instead of their present problem. In order to overcome this barrier I have formulated a SMART goal. A SMART goal is an acronym for Specific, Measurable, Attainable, Realistic and Time bound. My SMART goal is specific to myself as it will provide me with the opportunity to develop my personal and professional learning and development. Project Basic Patient Care Essay Paper

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