Who do I need to involve?
Myself, my Mentor, Infection Control Nurse, Clients and Evidence based Theory.
Outcome and Evaluation 2
I feel that I act appropriately in the case of infection control. I achieved this by engaging the clinical and support services, the Medical and Nursing, Housekeeping, Catering, Laundry, Maintenance and Decontamination and sterile services staff, in the control of infection, and provide clients and carers with the information necessary to perform all necessary infection control functions. Through research I have can identify the rational for testing all new patients to the ward for MRSA and can identify when a test for Clostridium difficile should be carried out. However these are not the only circumstances in which infection control should be used. Infection control should be a priority whit any patient regardless of infection with MRSA or Clostridium difficile. Hand hygiene, the use of personal protective equipment, the safe use and disposal of sharps policies should be followed at all times to protect the patient, the health care professionals and relevant others such as family and friends. The NICE guidelines (2003) state that standard principles are in place to prevent healthcare-associated infections and measures for preventing infections associated with specific aspects of care. According to Infection Control Services (2009). The responsibility of the hospitals is to ensure that the management of an infection control programs are carried out by competent, qualified Infection Control Nurses and that provision is made for ongoing education for all health care staff. Taking infection control measures in practice has become second nature to me, and I hope that by continuing with research and evidence based practice I will be able to identify with more confidence when extra measures need to be taken and how appropriate certain aspects are to client care. Research is important in healthcare today and is part of the evidence-based practice that underpins nursing. This stemmed from government policies and the introduction of clinical governance (Kopp 2001, McSherry et al 2002).
Systematic Approaches to Client care 2
The purpose of this essay is to discuss the importance of client care whilst paying particular attention to holism and networks of health and social care services. I aim to show understanding of roles of members of the health and social care teams in order to maintain and enhance integrated care in practice. I hope to show this by participating in a range of essential nursing skills whilst working as part of a multi disciplinary team in order to meet the individual and holistic needs of clients. I will reflect upon my experiences from practice as a student nurse to evaluate implication for future practice and to discuss the appropriateness of client care. To provide evidence of understanding I will apply my knowledge to an experience of client care that I experienced on placement in a ward setting. I will adhere to client confidentiality while demonstrating what I have learned.
Networks of health and social care services relates to the provision and access to available care. These services are health care professionals from a variety of disciplines that collaborate to provide care for a patient/client as an individual. This collaboration is often referred to as a multi-disciplinary team (MDT). The range of disciplines is vast. The range that I, as a first year nursing student, the main professions that make up an MDT have come across includes, Nurses, Physiotherapists, Occupational Therapists (OT’s), Social Workers, Diabetic Nurses, Doctors, Speech and Language Therapists (SALT) and Psychiatrists. As I progress through my course I expect to work with additional professions, for example Rheumatologists. A multidisciplinary programme of care for patients should be individually tailored and designed to optimise each patient’s physical and social performance and autonomy (Man et al. 2004). Depending on what ailments an individual client has, determines what members of an MDT should be involved in the clients care. Members of an MDT can be introduced at any stage in a clients care as required. For example a Physiotherapist could be introduced to a clients MDT during rehabilitation.
It is a key aspect of working within an MDT that professionals know their role in relation to the clients care in order for the care to be efficient and appropriate. To ensure this, members of an MDT should work collaboratively. Collaboration between health professionals is essential in ensuring quality care (Chaboyer and Pattinson, 2001). Sharing a clients medical and nursing notes with all members of the MDT is a form of collaboration; this implies interdependence and relies on mutual respect and understanding of the individual and complementary contribution each professional makes to achieve the desired care outcomes (Makaram, 1995). These notes can be in a form of an integrated care pathway. A definition as expressed by Harrison et al (2004) says that an integrated care pathway (ICP) is a multi disciplinary care plan that provide detailed guidance for each stage in the care of patients with specific conditions, over a given period of time and are used for day to day monitoring and quality assurance. ICP’s help ensure that members of health and social care teams maintain and enhance integrated care, as ICP’s provide role clarification, consistency of standards, a record of events in order, a variance which allows individualised components of care and a reduction in waiting times.
Case conferences are also a form of collaboration within an MDT and can also include the client themselves and the client’s family. A case conference is an opportunity for all members of an individual client’s MDT to evaluate the client’s care. Communication between the health professionals involved with the client’s care can be used as a teaching opportunity both for the client, their families and other professions. For example what is going to happen next, how that will affect the client and how that will influence the ICP. Case conferences can be held at any stage of a client’s care. As a student nurse I participate in collaborative care within an MDT, the experience that I have gained by doing this has helped me identify the needs of clients appropriately and enabled me to provide the right care, in the right order at the right time all with attention to the client’ experience.
To demonstrate the appropriateness of client care I will apply this essay to a client that I cared for whilst on placement. To do this aptly and effectively to seek consent from the client that I wish to study. Informed consent is vital before individuals can take part in a research study (World Medical Association Declaration of Helsinki 1997). The data protection act (1998) states that organizations have a duty of confidentiality towards their clients and any personal information held by an organization should not be shared or distributed without prior consent from the individual concerned, for example health records. It is the client’s decision to partake in any research, to gain this we must make it possible for them to give informed consent. It is important to let the client know that withholding consent will have no impact on their existing care or their future care, some people may feel obligated to consent in fear that they will face repercussions (Wilson et al. 2000). It is important to let the client know how and why their information is being shared to respect their right to confidentiality (Nursing and Midwifery Council, 2008). From evidence that I gather from evaluating the appropriateness of the clients care I hope to demonstrate my understanding of the importance of providing the right care to the right client at the right time, whilst providing evidence that shows that I recognise the importance of providing and maintaining accurate records. For the purpose of this essay I will refer to the client as Gerry.
Gerry was admitted to the ward after a fall at home. Diagnostic tests performed by preliminary members of his individualised MDT such as radiologists, doctors and nurses, revealed that Gerry had rheumatoid arthritis and an extension of a CVA (stroke) and a fractured neck of femur. After diagnosis we could adapt Gerry’s ICP so that it would be appropriate to his care. Gerry’s MDT therefore consisted of the fracture clinic, to assess his fractured neck of femur, Physiotherapists for rehabilitation, OT’s to assess how well Gerry could manage at home alone, doctors to prescribe medications, surgeons to repair his fracture, nurses to conduct observations and to give medications and personal care and a SALT to assess Gerry’s speech and swallowing capabilities in relation to having a stroke. Accurate record keeping maintains good communication between professionals in order to deliver the most efficient and appropriate care for clients. Accurate record keeping is essential for all health professionals. Legislation such as the Human Rights Act (1998) and the Data Protection Act (1998) have increased access to medical records so it is important to follow the guidelines stated in the ‘Code of Professional Conduct’ set by the Nursing and Midwifery Council (NMC, 2008). The ‘Code of Professional Conduct’ states that the health care record for the client is an accurate account of treatment, care planning and delivery. It should provide clear evidence of the care planned, the decisions made, the care delivered and the information shared. It should be written with the involvement of the patient or client wherever feasible and completed as soon as possible after an event has occurred. This code of practice is to protect both the client and the health professional from both legal issues and care and treatment issues (Wood, 2003).
In reflection I feel that Gerry’s care was appropriate as many improvements were made to Gerry’s quality of life. The OT’s made it possible for him to return home as they provided adaptations to his house, including the installation of a ‘Careline’ package. He was much more mobile with the use of a Zimmer frame provided by the physiotherapists and he had a good understanding of his diagnosis and medication with help from doctors, surgeons and the nursing team. However I also feel that a case conference could have been useful in evaluating Gerry’s progress. Gerry’s MDT remained unchanged until discharge and some aspects of his ICP became less appropriate through Gerry’s rehabilitation and treatment. An example of this is that Gerry was kept on thickened fluids and soft diet during his stay on the ward despite him regaining his ability to eat and drink normally. Evidence of this is that he regularly bought sweets and drinks off the shop trolley to eat and drink, as he did not like the soft diet choices provided or the fluid thickener. I feel that by addressing this in a case conference, more regular SALT assessments could have been provided for Gerry and it could have been communicated to the nursing team that he could resume normal diet. This would have improved Gerry’s care, as he would have been happier with the extended choice of hospital provided meals. Gerry also had a social worker previous to his stay on the ward, I think that it would have been appropriate to involve them as part of his MDT during his stay in hospital, it wasn’t until Gerry was due to be discharged that they were involved in his ICP.
According to ‘Advanced Health and Social Care’ (Moonie, 2000) networks of health and social care services refer to the arrangements made by society to manage illness, prevention of illnesses, rehabilitation, disability, premature death and epidemics. These arrangements have to take into consideration individual’s lifestyles. People’s lifestyles can be identified by analysing factors such as social, the environmental, cultural, legal, political and economical. To enable health and social care networks to meet these arrangements, the system has to be regulated. This includes regulating the access to available care, finance and organising the delivery of care (Field, 1989). In relation to Gerry’s care, environmental factor was an issue. He was not coping in his own home environment and he was at risk of falls. His individualised ICP made it possible to rectify the problems that he had. The Social Exclusion Unit Paper ‘Opportunity for all’ (1999) suggests that some communities such as older adults are trapped outside mainstream society and the problems that this leads to includes poor access to health services, poverty and lack of access to governmental support such as failure to comprehend government paperwork for additional financial support. This was the case for Gerry due to his mobility and recurrent speech difficulties.
According to OED (1996) Holism is the treating of a whole individual, this includes mental and social factors not just the symptoms of the disease. The factors that aid holistic nursing is looking at the patient or client’s individual physical, spiritual, psychological, environmental and social needs. Hunter (2009) suggests that a holistic approach to nursing can aid decisions on best treatment course. Essential nursing skills that aid individual and holistic needs of clients includes being able to build a relationship with the client in a professional manner from drawing upon communication, experience, research and intuition to recognize the totality of the person (Dossey, 2008). When reflecting on these skills I feel that in relation to Gerry the care he received on the ward by the MDT was medically good and achieved all the ICP outcomes. However in order for his care to based on a more holistic approach it would have been appropriate for Gerry to be involved in decisions made by the MDT, I feel that he was given little opportunity to voice concerns and preferences to those that did not have the chance to sit and converse with him. Ultimately it could have been these professionals that made the most influential decisions that would affect Gerry’s life upon discharge from the ward. I feel that I had did have the change to hear Gerry’s opinions and preferences whilst caring for him, and anything I learned from these brief discussions was documented in his nursing notes. However I should have used this opportunity in a more holistic manner in order to record more specific information that could have influenced his care. To be a holistic nurse it is important to be vigilant with patient assessments in order to avoid contradictions in treatments and to provide the best course of treatment for the individual patient, it is important to treat the patient and not the diagnosis (Hunter, 2009).
In conclusion, clients should have individualised ICP’s and appropriate MDT’s that should be re evaluated frequently in order to provide efficient and effective care for the client. Good communication within the MDT is important to provide optimal care delivery to ensure the best quality of life possible for the client is achieved. When looking at a client as an individual I have leaned that it is important to take influencing factors such as environmental, social, economical, spiritual and political into account as it can provide understanding of appropriateness of care for each individual client as a whole. From evaluating and reflecting upon the approach to client care I can implement what I have learned into future practice while developing my understanding and building on my knowledge of client care, doing so in a holistic manner.
References CFP 108
Chaboyer, W.P. and Patterson, E. 2001. Australian hospital generalist and
critical care nurses’ perceptions of doctor-nursecollaboration. Nursingand
HealthSciences, 3(2), pp. 73-79.
Dossey, B. and Keegan, L. (2008) Holistic Nursing: A Handbook For Practice, Boston: Jones and Barlett
Field, M.G. (1989) Success and crisis in the national health systems, London: Macmillan
Frisch, N. (2001) ‘Standards for Holistic Nursing Practice: A Way to Think About Our Care That Includes Complementary and Alternative Modalities’, The Online Journal of Issues in Nursing, 6 (2).
Great Britain. Data protection act 1998: Elizabeth II. Chapter 29. (1998) London: The Stationery Office.
Great Britain Human Rights act 1998: Elizabeth II. Chapter 42. (1998) London: The Stationery Office.
Harrison, M., Hall, J., Howard, D., & Mitchell, D. (2004) Integrated Care Pathways: the ‘acute’ context. Acute Mental Health Nursing – from acute concerns to the capable practitioner. London: Sage Publications Limited.
Hunter, S. (2009) ‘Holistic assessment of patients with COPD before the use of non-invasive ventilation’, Nursing Times, 105 (20)
Infection Control Services, Available at: http://www.infectioncontrolservices.co.uk/intro1.htm (Accessed: 01/08/2009)
Laurel A., Hurley, C., Dolan, N. (2007) ‘Principles of Infection Control’ Journal of Nursing Scholarship. 39(1) pp.82-87
Makaram, S. (1995). ‘Interprofessional cooperation’. Medical Education, 29 (9).
Man, W.D.C., Polkey, M.L., Donaldson, N., Gray, B.J., and Moxham, J. (2004) ‘Community pulmonary rehabilitation after hospitalisation for acute exacerbations of chronic obstructive pulmonary disease: randomised controlled study’, British Medical Journal, 329, pp. 2-5
Meredith, B. (2005) ‘Data protection and freedom of information’, British Medical Journal, 330, pp. 490-491
Moonie, N. (2004) Advanced Health and Social care, Third Edition, Oxford: Heinemann Educational Publishers.
NICE guidelines Prevention of healthcare-associated infections in primary and community care Available at: http://www.nice.org.uk/nicemedia/pdf/Infection_control_fullguideline.pdf (accessed: 01/08/2009)
NMC (2008) ‘Code of Professional Conduct’ Nursing and Midwifery Council, Available at: http://www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=3954 (Accessed: 31/07/2009)
Social Exclusion Unit (1999) Opportunity for all, London: HSMO
Wilson S., Delaney B.C., Roalfe A., Roberts L., Redman V., Wearn
A.M. & Hobbs F.D.R. (2000) Randomised controlled trials in
primary care: case study. British Medical Journal 321, pp.24-27.
Wood, C. (2003) ‘The importance of good record-keeping for nurses’, Nursing Times 99(2), pp.26- 28.
First Marker’s Signature ___________________Date__________
Second Marker’s Signature _________________Date__________
NMC Practice Outcomes Achieved YES / NO