It is clear in the article that Dottie hasn’t been person centred care. The nurses involved in her care weren’t aware of her needs. Frail older people are vulnerable and services for them should be designed in accordance with their needs (DH, 2001). If she has had an appropriate assessment since the first day of her admission, the nurses in charge of her care could pick up her needs for discharge. The staff probably would know that Dottie is deaf and that she probably wasn’t understand the question asked to her during the discharge assessment. The discharge assessment starts on the admission when patient’s needs are anticipated and identified, and a care plan developed. Discharge planning is a centralised, coordinated, and multidisciplinary process that ensures that the patient has a plan for continuing care after leaving the hospital (Potter and Perry, 2007). She hasn’t been involved in the process of discharge and staff wasn’t aware of her limitations. They also haven’t knowledge about her psychological terms; the fact that she has been spent some time in the hospital could make her confused and very anxious about the situation.
‘The National Service Framework for Older People (DH, 2001) identifies a framework for person-centred care using a single assessment process, which promotes dignity and personal choice’ (Nursing Standard, 2005). This single assessment aims good assessment practice by the professionals involved and to assist information sharing between professions. The person centred assessment will establish and attend the needs of this person.
To deliver person centred care, the health professionals need to listen to older people, respect their dignity and privacy, recognise individual differences and specific needs, enable older people to make informed choices, involving them in all decisions about their needs and care, provide coordinated and integrated service responses and involve and support carers whenever necessary (DH, 2001). It can be achieved if professionals understand patient’s needs, placing the patients in the position of take the decisions and engaging in a positive relationship with them.
The incident took place in a hospital setting, and hospitals in generally are depressed and isolated environment, no one likes to be in hospital and nurses have a role of try to make the time the patient spend in hospital less stressful as possible. One way of ensure it is through communicating with patients. Communication is essential to nursing and may influence the quality of care given. It helps to build up a relationship with the patient, and nurses need to take time to listen to and understand patients’ experience and expectations and doing it, nurses can demonstrated to patients that they are value as a person and make them feel that they have been cared and respected.
Patient centred communication allows the patients to have influence over and input into their health care, it is the key to allow patients’ choice. This communication turns nurses’ attention to the values and needs of the patients, making nurses less task- orientated.
The biggest challenge in nursing practice may be work in an environment which is not person centred. , even if the system aims to be person centred. Hospitals are a very busy environment and nurses tend to be system focuses instead of patient focused (Chang and Daly, 2008). This is what happened with Dottie: the nurse who did her discharge assessment was focused on the task rather to the patient, even if she didn’t intend to do it. The nurse was focused on making the system work and not on the patient needs as the assessment process needs to be placed in the context of government policy and organizational priorities, like the need of empty beds.
Elderly people are the largest category of patients in the NHS and have become an important priority group. Old age brings many symptoms, such deafness, arthritis, and confusion, and mental confusion can be increased by the intervention of health professional staff (Levitt, Wall and Appleby, 1999) while they are in hospital and problems often arise after discharge because he professionals involved in their care don’t take account of their home situation.
The NHS Plan (DH, 2000) aims to shape its services around the needs and preferences of individual patients, their families and their carers, offering a fast and convenient care delivered to a standard, with services available when people require them and tailored to their individual needs as patients are the most important people in the health service. It aims to shape the care around the convenience and concerns of patients, giving patients new rights and new roles within the health service.
The Standard 2 of National Framework for Older People - NSF (DH, 2001) ensure that older people are treated as individuals and they receive appropriate and timely packages of care which meet their needs as individuals, with NHS and social care services treating older people as individuals and enable them to make choices about their own care. It says that they should receive person-centred care and services which respect them as individuals and which are arranged around their needs.
Seems that the nurses who were looking after Dottie haven’t designed a care based in her needs as individuals, so they weren’t able to identify key points on Dottie’s life would make difference in the way that nurses delivery her care. Against the NSF for Older People, Dottie hasn’t been centred care and hasn’t have been provided with services based in her needs. Probably, because they were so task-orientated, they could realized that a good assessment involves communication with the patient and not just ask question and tick boxes. A good example in the article that nurses were task orientated is the fact that nurses supposed that Dottie was pain free because she was refusing the analgesia. A person centred nurse would ask the reason why the patient is refusing its medication.
Nurses, as all every body, have personal values, which can be identified as part of nursing personal knowledge identified by Carper (Basford and Slevin, 2003) , and these values may influence the way of care is delivered. Nurses will be helped to be centred care and act in the best interest of older people if the values about nursing older people are clarified, ensuring that decisions and acts are value based ,identifying which ones could be explored in order to develop a less biased care (Neno, Aveyard and Heath, 2007).
The fact that Dottie hasn’t been centred care can also be attributed to the negative stereotype of old people, as the society in general see only the negatives aspects of ageing, such as illness, dependency and mental deterioration (Ramsden, 1999). This negative view drives the society behave negatively towards older people, causing failure to respond to their needs (Basford and Slevin, 2003). Nurses, as part of society also may have this negative view and hold negative attitudes towards them not paying enough attention when nursing older people.
The NSF for Older People (DH, 2001) reinforces the need for respecting the individual, triggered by concerns about widespread infringement of dignity and unfair discrimination in older people’s access to care. It goes against age discrimination and ensures that older people are treated with respect, according to their individual needs, and says that NHS services will be provided, regardless of age. It also adverts that the lack of skills and confidence of the staff who work with older people can lead to discriminatory behaviour. Nurses need to recognise the older people as person, accepting their rights of life, respecting their wishes and capabilities; also nurses need to commit themselves to the primacy of care (Basford and Slevin, 2003).
Nurses need to develop a better understand of their working-role and their responsibilities. Professional identity comes from the character role based on the profession (Hornby and Atkins, 2000). The NMC specify the professional aims, attitudes, and values in their Code of Conduct (2008), which has some person centred care principles, such as treat people as individual, respect the role of patients as partners in their care, and identify and respect their preferences regarding care.
The article doesn’t say which health care professionals were involved with Dottie’s care, however can be supposed that at least nurses, health care assistants and doctors involved with her care. Also, it is not clear how involved in Dottie’s care these supposed professionals were and if they have worked together. The NMC Code of Conduct (2008) says that nurses should work with others to protect and promote the health and wellbeing of those in their care and work effectively as part of a team. All health professionals involved with Dottie should be worked together in a collaborative way, sharing information, when appropriated, in order to deliver an effective person-centred care. Nurses’ roles are expanding every day and many times they find themselves working, as part of a team, with many healthcare professionals. The skill of teamwork needs to be learned as part of continuing professional development, however meeting patient’s needs collaboratively is difficult when professional attitude and culture prevent it (Kenny, 2002).
Collaboration means working together to achieve a common purpose, and making and maintain the relationship necessary to deliver care takes time and effort from all professionals involved. It intends to provide an integrated care for a particular patient trough coordinating services, and to provide a kind of care achieved where there is interactive work between professionals involved (Hornby and Atkins, 2000). Kenny (2002) says that interprofessional collaboration requires nurses share their values beyond the professional boundaries, where professions recognise that other disciplines have an important contribution to make. Interprofessional is where professionals make a commitment to work with each other across boundaries for the benefit of the patient, keeping the focus on the patient.
Interprofessional collaboration also involves the patients’ participation, give them the right choose the best for them. It also involves effective communication between the team and the record of patient health care plan, which should be individualized, patient centred, and based on the needs identified on the assessment process. The article gives the idea that Dottie hasn’t had a suitable assessment and care plan done. As mention before, it is not clear which health professionals have been involved in Dottie’s care and how deep this involvement was, however can be presumed that none of them have been centred care and able to identify the points that could mislead her care, as they have past important points in her care such as not realize how debilitated she was.
CONCLUSION
Dottie was past care in many ways. The health care professionals, whose look after her, have been person centred care. She hasn’t had the right of choices of her care, and she hasn’t had a suitable assessment done. Her needs haven’t been correctly identified, and nurses weren’t aware of her emotional and psychological states.
The nurses were tasked orientated, missing points about Dottie such as the fact that she is deaf, and it not clear if Dottie didn’t heard the questions of the discharge assessment or if she answered whatever she want because she wanted to go home as she was frightened to be in hospital.
The Dottie’s assessment wasn’t contextualised along with her needs, wants and aspirations as she couldn’t exercise her freedom of choice, express her opinions, engage in decision-making, communicate, and be heard. The care delivered to Dottie wasn’t tailored around her needs and they weren’t the base for decision making.
The other health professionals involved in her care also haven’t been centred care. Lack of communication between them was present in the interprofessional relationship, however the article doesn’t make any comment about other professionals involved in Dottie’s care, but it can be presumed by the fact that she was discharged from hospital in a very debilitated state, and discharge process involves other professional other than nurses.
Nurses and all other health professionals need to be more focused on their patients rather than fill paper only.
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