Hinchliff et al (2003) state that conscience should not be used as an abdication of professional responsibility to give care to individual patients or groups whose lifestyle, personal habits or diagnosis are offensive to the practitioner. Nurses are to provide appropriate treatment and support in emergency situation, ethical refer to values, beliefs, human right, justice, confidentiality and personal viewpoints and respect patients. Nurses must provide caring qualities, being non-judgemental and not discriminating, accepting of patient, empathy and having therapeutically close relationship with patient. (Hogston and Simpson, 2002).
Discrimination refers to activities which serve to disqualify the members of one grouping from opportunities open to others. As when a patient is discriminated because of his illness. Hogston and Simpson (2002) state that practicing in an antidiscriminatory way means both acknowledging the sources of oppressing in people's lives and actively working towards reducing them.
Ethical issues often arise to question the principle of confidentiality and create conflicts. Examples will be from my placement experience where I worked with patients experiencing mental health illness. I will look into the client's right to confidentiality. A patient of mental health condition, who is a schizophrenic patient turn to be aggressive toward the nurses and other patients and clients. He is on daily medication to manage his aggression. He attended the Occupational Therapy and being in change of him, he has been talking to me in confidence his isolation from his family. He further said that due to the side effect of the medicine he occasionally doesn't bother to take it.
In my first placement, one of the patient in the ward, a white lady, had paranoid schizophrenic, she was abusive and called nurses racial names, she shouted abuses and told them to go back to Africa. Even though she had never abused me, some of the staff told me to stay away from her. I overlooked this patient for the first two weeks, and then I realized that I have neglected her, which was unprofessional. I was discriminating against this patient and was not giving her holistic care she need. Kenworthy et al (2003) state that mental health nurses regard the creation of relationships with their clients or patients as the center of their work. I changed my attitude toward her and build a therapeutic relationship with this patient base on trust, respect and understanding. I was surprised how this patient opened up to me and was friendly with me. Even though she continued with the verbal abuses against other staff, I was able to communicate with her and calm her down when she was showing bizarre behaviour and violence toward others.
Upon reflection, I recognized my own strength and weakness, I realized that whenever a patient become aggressive, I failed to attend to him and was unable to deliver therapeutic care that they needed. As student, I am allow to make mistake, I acknowledge the importance of seeking supervision to me develop safe nursing practice. As my course progress I shall continue to learn more personal and professional knowledge and experience to develop more skills
CARE DELIVERY
Nurses’ role is defined by Henderson (1969) as to assist the individual sick or well in the performance of those activities contributing to health or its discovery that he would perform unaided if he has the necessary strength, will or knowledge. It is important to promote the well being and health of the patient. Hinchliff et al (2003).
Care delivery is an integrated approach or pathway, which determines and utilizes locally agreed multidisciplinary practice based on guidelines and evidence for a specific patient or client group. It may form part or all of the clinical record, it documents the care given and facilitates the evaluation of outcome Barbara, Weller. (2002). This is also base on the specific numbers, proportions, or ratios of nurses to patients, nurse availability variables generally characterize the number of hours nurses spend with patients.
Assessment state is the first phase basic of the nursing process and it forms the basis of the nursing diagnosis. It sets the basics for the remaining steps of the nursing process Bradley et al (1990). Activities of daily living frame lists of client’s activities such as maintaining a safe environment, communication, breathing, eating a balanced diet, and drinking, eliminating, mobility, controlling body temperature, sleeping, working and playing, expressing sexuality, dying, Hogston and Simpson (1999). Nursing assessments is used as interventions, such as risk assessment, pressure ulcer risk assessment, or identification of patients at high risk for malnutrition, to reduce adverse events. In multidisciplinary procedure, the nursing activity is often assessment, rather than a nursing process or procedure. Kenworthy et al (2003).
Hinchliff et al 2003 state that the nursing assessment includes the development and documentation of nursing assessments and participating in comprehensive, systematic nursing assessment of the physical, psychological, social and spiritual needs of the patient.
In care delivery, a nurse is to demonstrate a range of important nursing skills, under the supervision of a registered nurse, to meet individuals’ needs, which include, maintaining dignity, privacy, and confidentiality, as well as effective communication, and observation and listening skills. Kenworthy et al (2003).
Health and safety including moving and handling, are very important part of care, because is to prevent nurses causing harm to themselves and to their colleagues and patients. Care also includes how infection is control in the ward, such as washing hands using protective clothes such as glove and apron, administration of medicine giving the correct dose and to be aware of emotional and physical personal care of the patient.
There is the need to develop a therapeutic relationship and to promote the patient’s wellbeing in delivering care. This involves giving the patient a choice and empowering them through providing them with the necessary information. Data collection is an essential part of the assessment process and this in turn helps to the planning implementing and evaluating the care process. Maintaining the patient’s privacy and dignity as well respecting and protecting their confidentiality is part of the nurse’s duty of care (Hogston and Sampson 2000).
According to (NMC 2002) code of professional conduct, Information about patient must be treated as confidential and used only for the purposes for which it was given. Nurse should not disclose patient’s information with other patients, or talk on the phone with unknown caller.
Nurses are to discuss with patients and clients to identify their need and wishes for health promotion advice and to provide relevant and current health information to the patients. Which will be easy for the patient to understand and to acknowledge individual choice, as well as to provide support and education in the development of independent living? Hinchliff et al (2003). Example if patient wants to give up smoking because is bad for his health or not bother.
Communication form a very important and essential part of a good practice NMC guidelines for professional practice (2002). Arnold and Boggs (1999) also state that communication with colleagues and patients is an important fundamental requirement for improving patient care.
Walsh (1991) states that high priorities occur in physiological and psychological needs, intermediate priorities involve non-emergency, non-life-threatening needs and low priorities may not be directly related to a specific illness or prognosis. The short-term therapeutic aims for patients were to minimize the extent of any harm and distress, to help them overcome safely any dependency to the drugs they were taking and to facilitate the development of their coping skills.
Due to my concern, I asked him if he is aware of the implication of not having proper amount of medicine. Being very clear about the consequences, I further reinforce this and explain that because of his aggression other patients are afraid that he may hurt them. He told me the medicine has made him impotent and he does not want to take it continually. I have advice him to tell the doctor about the side effect but he declined. According to his culture he fined it very difficult to talk about his private life. The client believes that I would not reveal his information, he told me not to tell any one, he will tell the doctor in his own time.
I reported this to my mentor as I think there is a risk that he may harm others or endanger himself, to protect others I felt it would be better for the registered nurse to persuade him to tell his doctor to review his medication. The Code of Professional Conduct NMC (2002) supports the practicing and registered nurses and argues that confidentiality can be overridden if it is in the public interest. Despite the fact that confidentiality is not an absolute guarantee, it can be seen as a key ethical issue and guideline to good practice. All nursing codes of ethics have a clause regarding confidentiality.
In reflecting back, I realised that I did not spent enough time with the patients. I also did not ask them how they felt, after taking their medication and did not observe him for any side effect. After spending four weeks in the ward I was able to talk to patient about their medication and asked them how they felt after taking their medication.
PERSONAL/PROFESSIONAL DEVELOPMENT
For professional development, the NMC (NMC 2002) states that a nurse must keep their knowledge and skills up to date throughout their working life.
It is therefore the responsibility of the individual nurse for their own learning through the development of practice. Such as to identify additional knowledge and skills needed to manage unfamiliar or professionally challenging situations (Kenworthy et al 2003).
This also demonstrate one’s commitment to the need for continuing professional development and personal supervision activities in order to enhance knowledge, skill, values, and attitude of safe and effective nursing practice.
The need for continuing professional development is vital for all staff in health care delivery. Registered Nurses, Midwives and Health Visitors are the key professional people, who have the skills, knowledge and ability to make a difference to the delivery of health care. Personal career development can be at a pace to meet both one’s professional and circumstances. The gaining of new knowledge and skills is vital to nurses as well as making the difference to the type of health care they deliver Hinchliff et al (2003).
It also contributes to creating a climate conducive to learning experiences and development of others by facilitating the mutual sharing of knowledge and experience. When practitioners do not comply with the UKCC (1995) standard and the maintenance of a personal professional profile, they will be considered to have allowed their own registration to lapse. All Learning activity needs to be recorded in a personal professional portfolio. This enables the individual to demonstrate to the NMC all learning activity that has been undertaken. Kenworthy et al (2003).
Kenworthy continue to sate that one has to identify their own professional development needs by engaging in activities such as reflection, on practice and lifelong learning, and to develop a personal development plan which take into account personal, professional and organizational needs. One’s experience should be share with colleagues, patients in order to identify additional knowledge and skills needed to manage unfamiliar or professionally challenging situation.
UKCC (1992) emphasis that pre-registration curriculum will continue to change over time to absorb relevant changes in care as advances are made. Pre-registration education is therefore, a foundation for professional practice and a means of equipping nurses, midwives and health visitors with the necessary knowledge and skills to assume responsibility as registered practitioners. Further education will equip practitioners with additional and more specialist skills necessary to meet the special needs of patients and clients.
Hogston and Simpson mention that nurses need to access their own thoughts, feelings and motivation for behaviour to be able to have an awareness of how they may respond to the thoughts, feelings and behaviour of other. There is an acknowledgement within the field of health care that nurses need to demonstrate positive regard. Nurse aim is to promote a sense of value in their patients, but in order to be successful, they need to have understanding of themselves in terms of their values, attitudes, thoughts, and feelings and to be comfortable with oneselves before they can understand others.
NMC (2002) code of professional conduct state that one must keep his or her knowledge and skills up to date throughout their working life. It is important for one to take part in learning activities that develop one’s competence and performance. One must possess the knowledge, skills and abilities required for lawful, safe and effective practice without direct supervision.
Hinchliff et al (2003) emphasis that a nurse must acknowledge their limitation of professional competence, example, if one is ask to take a task that is beyond their level of competence or outside their limitation, then they should obtain help and supervision from a competent practitioner. A registered nurse is to assist student nurse to develop their skills. It is the responsibility of a registered nurse to deliver care based on current evidence, best practice and where applicable, and available validated research.
Peplau’s model maintains the belief that individuals have the right to autonomy, self-direction and decision-making within their capabilities. I used this model to relate to James needs, which were physiological, psychological support and care. Peplau’s model is that the patient should be moving towards health, and that the nurse has the roles to educate and empower the patient. Hinchliff (2003).
I have identified the needs for my personal development by working with my mentor and other trained nurses by engaging in activities such as observation, communication and working in a team. This has highlighted the need for me to develop skills and to gain knowledge as well as confidence in order to provide quality care to patients. My mentor explained the (UKCC) code of conduct to me, and how the code of regulation was set up to protect the public and to maintain standards through reflection and appraisal.
During my placement in Newham hospital, I was giving a task to observe Adam (pseudonym), who was 30 years old and had Multiple Sclerosis (MS). He was in a terrible emotional state and refusing to eat or maintain his personal hygiene. I build a therapeutic relationship with Adam based on trust, empathy and understanding and listening. I went to his bedside and asked him if I could talk to him, I asked him the reason for his depressing. He told me his fiancée visited him the day before and told him she has broken up with him, he said he felt abandonment and depressed. He told me he would prefer to be transfer to Walsh hospital to be closer to his parent. I reassured him and I prompted him to eat and gave him adequate fluid intake. I encouraged and supported him to take his bath, I changed his bed with clean sheets and gave him clean clothes and make sure he was comfortable. I told my mentor what happened to Adam and she went and had a chat with him. Before I left the ward that evening, Adam felt much better and was cheerfully chatting with another patient.
Upon reflection, I used my communication skills to listen carefully whist Adam was telling me about his problems. I realised that I did not get the patient’s consent before informing my mentor about his problems. I have not spend enough time with him due to other tasks I was given. As a student, I am allowed to make mistake and learn from it. I will make sure next time to spend enough time with patient who is having emotional problems and will make sure I asked his permission before I give any information concerning him.
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CARE MANAGEMENT
The duty of a nurse is to promotes, advocates and make every effort to protect the health, safety, and rights of the patient receiving care. In the ward the nurses ensure that the environment is safe for the patients and clients, for example the patient paths are not block with chairs, boxes or any electrical wire left around .and to ensure that floor was not wet.
I observed how nurses deal with ethical issues everyday as they interact with patient, families and other health care providers. Regarding professional and ethical practice, a registered nurse must be able to manage themselves and their practice and that of others, according to the code of professional conduct of UKCC (1995).
Care management contributes to the identification of actual and potential risks to patients, clients, and their carers, to oneself and to others and participates in measures to promote and ensure health and safety. Also to understand and put into practice health and safety principles and policies, as well as recognise and report situations which are potentially unsafe for patients, clients and oneself and others Kenworthy et al (2003). One must make sure that relevant principle were apply to ensure safe administration of therapeutic substances and to use appropriate risk assessment tools to identify actual and possible risk such as environmental hazards and to prevent it.
This involves the need to identify how to utilize risk management tools in assessment for example the waterlow score. To demonstrate the key of skills of effective communication, maintaining a safe working environment, by the use of assurance and appropriate risks assessment, such as to identify hazards and to eliminate or prevent it. NMC (2002) code of professional conduct states that a nurse must work with other members of the team to promote health care environments that are conductive to safe, therapeutic and ethical practice. A manager must have the duty toward patients, clients, colleagues and wider community and the organization in which one work. NMC also states that whether in emergency or outside work setting, one has a professional duty to provide care.
As a student, I establish and maintain collaborative working relationships with members of the multidisciplinary team and took part in the assessment of the patients. Kenworthy et al (2003). Hinchliff et al (2003) state that teamwork introduced in 1980’s, was a way of ensuring more holistic care. According to the NMC (2002), team work includes the patient, their family and thier carers, I worked as part of a team by reporting issues observed to the nurse in charge and respected the skills, knowledge and expertise of other members of the team. I listened carefully to how they discuss and solved difficult situation, such as controlling violence and abusive patients. I also asked questions and discussed about patients condition with registered nurses.
It is the duty of ward manager to demonstrate the ability to coordinate the delivery of nursing and health care and to delegate duties to other staff as appropriate and to ensuring that they are supervised and monitored. Also the staff nurses are to be computer skills to be able to record patient’s information on the computer and to be able to retrieve it, and accurate numeracy, Hinchliff et al (2003).
During my placement in Kings Square Nursery, the manager in charge of the nursery make sure that we care for the children and try and create a good environment for them. This means I made sure that the place is safe, hygienic and that the equipments and activities that are provided are suitable for the needs of the children being care for. I was asked to check to make sure that there was no potential hazards, I supervised the children and make sure that equipments and materials are right for their age. I was asked to take responsibility for tidying away equipments so that accidents are prevented and the environment is kept clean. All the staff were involved in wiping spillage and cleaned up surfaces to prevent the children being sick. I asked my supervisor or manage any thing I wanted to know about the children and keep it as confidential. NMC (2002).
The staffs also establish good relationship with the parents, this help the children to settle in more quickly, I get on well with the children by spending much time with each patient to build relationship and trust. I also supported the need of the individual children. For example, when a child want to go to the toilet, I help them and to take their clothes and after they have finished I help them to watch their hands. I also helped them to do their act works as well as help them in the play ground. I also played part as a team member and was able to work with the staff. As a good team member, I respected the members of the team and supported them.
I reflected upon, as a mother, I was able to used my skills of observation to prevent the children from injuring themselves. Used motherly love experience to provide for the children needs. I identified the roles that each member of care team played and how the nursery identify environmental hazards and eliminate and prevent them where possible. I also observed how the nursery applies appropriate rules to make sure of the safe administration of therapeutic substances. As a student I need to learn more about child care and to continue to practice and experience under supervision of a registered nurse.
References:
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Hinchliff, S., Norman, S. and Schober, J. (2003). Nursing practice and health care 4th ed. London:Arnold. -
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Jarvis, P. (1991) Reflective practice and nursing. Nurse Education Today, 12,174-181.
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Kenworthy, N., Snowley, G. and Gilling, C. (2003) Common Foundation, Studies in Nursing 3rd ed. Edinburgh: Churchill Livingstone.
- Nicol, M., Bavin, C., Bedford-Turner, C., Cronin, P. and Rawlings Anderson, K. (2004) Essential Nursing Skills. Londdon: Mosby.
- Hogston, S. and Simpson, P. M. (2002) Foundation of Nursing Practice. London: Macmillan.
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Burnard, P. (1995) Learning Human Skills 3rd ed. London: Guildford
- NMC code of professional conduct (2002). London: NMC
- UKCC code of professional conduct (1995) London: UKCC
- Walsh, Catherine (1991). Literacy as praxis: Culture, language and pedagogy: Norwood, NJ.