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Delivering Quality Nursing Care

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Introduction

Sandy, a 93 year old man, was admitted to the ward for rehabilitation due to reduced mobility following a fall at home. He has a medical history of vascular dementia, bladder cancer and chronic kidney disease. According to a report by the National Health Service (NHS 2017), suffering from a fall causes distress as well as a loss of independence and confidence so it is the role of rehabilitation to recover these and work towards achieving independence.

A study by Duffy (2013) shows that individuals who suffer from dementia or cognitive impairment are more vulnerable to falls so it is crucial that health professionals caring for the elderly carry out a holistic approach and management in relation to falls. The rehabilitation team was made up of a large range of health professionals such as physiotherapists and occupational therapists. Elliot (2013) suggests that a supervised exercise programme is essential to help aid patients to gradually increase their physical activity along with increasing their exercise capacity. Goals are set to each individual patient and exercises are set specifically for that patients’ needs so that the rehabilitation process is safe, enjoyable and meets the patients’ needs.

The main role was to promote independence and improve Sandy’s mobility, ensuring that he was safe in his home environment post discharge. Because of his reduced mobility and age, Sandy required assistance with transfers and all aspects of personal care, including care of his stoma bag. Throughout this essay, I will discuss the importance of person-centred care and the benefits of this as well as the input of other health professionals and their impact. I will finish off by discussing how I would apply both a piece of legislation and research evidence to my patient if he had a learning disability.

Delivery of Care Person centred care (PPC) is treating the patient as an individual and not just as their illness but still involving them in their care and allowing them to make their own decisions if they have the capacity to do so. Communication between nurses and patients is essential to promote recovery leading to a successful discharge. Scammell (2017) suggests that there is no single definition for patient centred care but there are five domains that make it up. These five domains include information so that the patient is informed of all care or treatment that they are receiving while there time in the hospital. Communication so that the patient feels valued and they can approach nurses if they are worried or have any questions. Decision making is made possible for the patient when discussions of treatment is made clear through effective communication. Care planning and coordination of care is necessary due to the involvement of patient families prior to discharge Scammell (2017).

PPC has health benefits for patients as they are able to build relationships with nursing staff and it makes it easier to find out their likes and dislikes which will help promote recovery and ensure discharge is an easy and simple process. Fredericks, Lampam and Hui (2015) states that person centred care provided patients with the chance to be actively involved with their care and the patients’ needs, values and beliefs are encountered for. This can benefit patients mental health during there say in hospital as they will have a more positive mind set.

The first aspect was getting to know the patient, I achieved this by asking Sandy questions such as his preferred name and through discussions I found out that he preferred to sit with the lights off during the day as he preferred the daylight shining in. We achieved this by ensuring everyone on the ward knew his preferred name and it was written on the board in his room so that other health professionals were aware. The lights were kept off until it was unsafe for him to be sitting in the dark. Due to Sandy having vascular dementia it was sometimes difficult to engage and communicate with him as he often forgot what was being said so the outcome was that Sandy showed nursing staff respect as he felt comfortable in the environment. Lindsay-Gould (2017) mentions that treating patients with a holistic approach and being non- judgemental of a patients values and beliefs is the key to good person centred care as it will make the patient feel valued and safe while they are being cared for.

The second aspect of PPC was finding out if Sandy could self-care for his urostomy bag. A urostomy is when a small section of the bowel is removed and connected to your ureters. A small hole is then created on the surface of the abdomen and the open end of the removed bowel is placed in this hole. A waterproof bag is then placed over the stoma to collect urine (National Health Service 2015). Due to Sandy saying he needed assistance with the care of his stoma nursing staff were able to organise a care plan specific to his needs. By explaining step by step and discussing what was being done while changing his bag it resulted in him being more relaxed while this was being carried out. The room door was closed and the curtain was shut to maintain the patients’ dignity. Mendes (2015) discusses that to maintain patient dignity is to treat them as valued individuals and the attitude a nurse holds while caring for the patient is a huge factor that promotes an individual’s dignity while in hospital. Nursing staff then showed Sandy how to empty the urostomy bag himself to promote independence.

The outcome of this was him having trust in nursing staff and as it was a personal procedure being carried out it allowed a relationship to be built. Trust is a huge factor of the nurse-patient relationship, nurses must demonstrate clinical competence and knowledge while carrying out a procedure because if something goes wrong the patient will be left feeling vulnerable to the trust in the nurse-patient relationship will be broken (Bell and Duffy 2009).

PPC has a positive outcome while trying to achieve patient empowerment. Promoting independence and encouraging patients to carry out self-care will make them feel more empowered resulting in patients being happier with the care they are receiving and benefiting greatly. By carrying out PPC health professionals are able to educate and discuss essential skills to every patient which will encourage them to be independent and confident while carrying out self-care (Phillips 2016). The importance of effective communication, successful practical teaching and teamwork are key factors to empower patients to self-care (Di Gesero 2012). Other health professionals were involved with the care of Sandy including physiotherapists. Carr et al (2016) states that physiotherapy is used to treat different injuries, diseases and disorders by applying physical methods such as exercises to increase mobility and restore a person’s quality of life.

Due to Sandy being admitted to hospital following a fall at home and reduced mobility physiotherapists were involved to try and bring him back to his baseline level of mobility. They did this by giving Sandy exercises and getting him to walk with different walking aids to see which one is best and safest for him to have at home. Carr (2017) mentions that a treatment plan is made for every patient with set aims and goals. These include maintaining the patient’s range of movement by providing the correct walking aids and support on how best to position and mobilise with them so that the patient is getting the full benefit of the walking aid provided. Sandy was provided with a zimmer frame and after input from the physiotherapists he managed to mobilise independently.

Older Adult

The research I found is about if balance confidence and fear of falling is the most predictive cause of falls in older adults (Landers et al 2016). According to Critical Appraisal Skills Programme (CASP) a robust piece of research evidence needs should include an aim, method, results and discussion. The article has an aim which is to determine which aspects such as physical and psychological are the most predictive causes of falls in older adults. Sixty-four participants took place in the survey, forty females and twenty-four males all with and without pathology. Participants had to complete a record of their past falls history within the last year and how the fall had happened whether they had simply just falling to the ground or if they were carrying out daily tasks. The CASP tool states that the recruitment strategy should be appropriate to the aims of the research and this article states that the participants were recruited by handing out print media to support groups, interested participants were to contact the investigator. The recruitment process was to a targeted group of individuals with a range of balance capabilities over the age of sixty years old. Individuals with the inability to read or speak English, cognitive impairment or unstable health conditions such as hypotension were prevented from participating in balance testing.

This research concludes that balance confidence was the best predictor of falls dues to patients having the fear of falling again resulting in them being a high falls risk. By following the CASP tool I identified that this is a qualitative and robust piece of research. The legislation I have chosen is the adults with incapacity (Scotland) act 2000 as it provides a framework for safeguarding the welfare and managing the finances of adults who lack capacity due to illness or condition that may affect their cognitive state. Families are giving power of attorney which allows them the authority to make decisions for the patient if have incapacity (Mental welfare 2017).

The research and legislation would be applicable to Sandy as he is an older adult who suffers dementia. Due to Sandy being admitted to the ward following a fall at home I was able to relate the research as I could investigate how he had ended up falling. The aim for Sandy was to have an easy and safe discharge home. The legislation is also relevant to Sandy as he has a power of attorney in place which was his niece so health professionals could consult her along with Sandy around issues involving his care. The ethics I considered while carrying out PPC to Sandy was ensuring that I maintained his privacy and dignity throughout his stay in hospital along with respecting his values and beliefs. I showed his family and other visitors respect and discussed Sandys care with them keeping him involved with decision making. The legalisation I choose had ethical principles such as respect and dignity as the family had power of attorney put in place so discussions of Sandys discharge home were discussed between nursing staff, Sandy and his family.

Future Practice

Throughout my last placement on a medical ward I have realised the importance of person centred care and how treating patients as an individual has benefits to their care. A patient receiving good PPC from nursing staff will allow strong relationships to be built resulting in the patients stay in hospital to be shorter and more likely for the discharge to be successful. I have learnt that communication between patients and nursing staff is essential to build a strong relationship as it is essential to promote a successful recovery. I am aware that involving patients in the decision making process of their treatment and promoting independence will result in the patient having trust in nursing staff and will allow them to see what they are capable of and what they may need a little help with. I believe that PPC is a very important factor as the patient will feel empowered while receiving safe and effective care. Ashurst (2015) states that person centred care has many different aspects such promoting patient individuality, independence, partnership, choice, dignity and respect. Including all of the above values in person centred care will allow the patient to live a satisfying and comfortable life while in your care. I believe that engaging and building a bond with a patient’s’ family is essential as a patients such as Sandy may not have the capacity to make decisions so it is important in cases like this that the family are involved with the decision making progress. In my future practice I will continue to develop my PPC skills. I will do this by spending time with patients and their families and finding out the patients values and preferences so that they can receive the best possible care during their stay in hospital. I will be an active listener and act quickly when a patient feels unsafe or unhappy with the care they are receiving.

This will result in trust and respect being shown to nursing staff and a strong nurse-patient relationship being formed along with the patient feeling empowered. *Sandy was a name given to the patient to maintain confidentiality.

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