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Evaluating Personal and Professional Development Requirements in Relation to the Nmc Regulation, Standards and Guidance Using a Service User Encounter

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In this exercise, an effort will be made to scrutinize some of the lapses found while going through the report tendered to the parliament and Health Service Ombudsman for England in 2011 regarding the quality of care rendered to elderly people by the National Health Service. In doing this, the Borton’s model of reflection (1970) will be employed in analysing personal and developmental requirements in relation to the Nursing and Midwifery Council, standards and guidance). Using the model comprises three elementary subject matters to be examined of the practice or activity to be reflected on, what? So, what? and Now what? According to Bolton (2010) reflection is a comprehensive consideration of incidents or situations independent of oneself; solitary or reducing the experience to bring it into a centre of attention. Bolton added that reflection on practice is a basic competence for nurses and engaging in consistent reflection allows healthcare professionals to manage the personal and professional impact of addressing their patients’ fundamental health and wellbeing needs daily. For bunches of reasons yet a vital aspect regarding reflection is that we can consider, plan and convey a high caliber of care to our patient’s/service users. All through this case study, the client in question will be referred to Mr. W in other to conform to the Nursing and Midwifery Council code of practice, which states that in all areas of patients care, their right to privacy should be maintained.

What?

In consonance with the case study from the Ombudsman report, Mr. W age 79 suffered from dementia and depression, was delicate and not long has he lost his wife. The patient was admitted to St Peter’s Hospital (part of Ashford and St Peter’s Hospital NHS Foundation Trust) with frequent dehydration and pneumonia. Mr. W was being treated with intravenous fluid and antibiotics due to a chest infection. Though treatment was later discontinued when it was ascertained that his chest has cleared. Seven days later, Mr. W’s daughter who was once a nurse told the doctor in charge of her father’s care of her worries about his general state of health that has declined since his stay in the hospital. Mr. W’s daughter suggested that intravenous fluids would be a good option because her dad regularly turns down food and drink. Despite her recommendation, the doctor still went ahead in discharging Mr. W to a care home without formal consultation with his family who ‘could do nothing to stop it’, claiming he was in good health for discharge. Also, the doctor stated he was weak and susceptible to further disease and that any further therapy should be palliative. He (the doctor) told Mr. W’s daughter that her dad was ‘probably as good as he is going to get’. Mr. W turned down most foods and only drinks a cup of liquid every day which continued over the next few days. Giving him food via a percutaneous endoscopic gastrostomy (PEG) tube though considered but was preside over because feeding patients with advanced dementia with PEG feeding have a high menace of demise said the doctor. A few days later at 2. 00am, Mr. W was admitted to another hospital with labored breathing. He was seriously dehydrated and had a chest infection. The hospital gave him good medical care and his chest infection cleared up. In addition to his treatment, Mr. W’s daughter told the Ombudsman that after her dad was fed via a PEG tube and given suitable food and liquid, he became regenerated and he had not been bedridden since.

So, what?

Looking closely at how care was rendered to Mr. W, it can be stated that attention to his essentials of care were compromised. As postulated by NMC (2015) fundamentals of care comprise, though not restricted to, nutrition, bladder and bowel care. It comprises ensuring `sufficient access to nourishment and hydration, and making effort to give assistance to service users who need care while ensuring those who cannot feed themselves or take fluid without assistance is helped. Mr. W’s health status alongside his age is a clear indication that he needed to be hydrated and nourished to keep up with the fluid balance in the body as well as his nutritional needs taking into consideration the risk associated with not getting enough fluid such as renal impairment as the kidneys play an important part in the control of fluid but with ageing, their function degenerate. Elderly persons are unprotected to dehydration due to bodily changes that takes place as they grow old. Therefore, improving fluid intake can lead to good health and a high standard of living for service users, lessen the use of medication and stop ailment. But this aspect of care was totally neglected in Mr. W’s case. This shows that a proper assessment of Mr. W’s health status was not carried out which would have served as a guide on how his care would be planned to meet his wants and needs. Treatment and care should consider patients’ needs and preferences. This is often the foundation of person-centered care meaning centering care on wants of the individual instead of wants of the resources. Effective assessment of a patient is essential to the well-being, continuousness and quality of care, and achieve the legal and professional duties of nursing practice.

Considering the domain of ‘nursing practice and decision-making’, student nurses are required to show the skills to go through in-depth, orderly nursing judgements and plan, implement and evaluate secure, competent, individual-centered care. Following steps in the nursing process which are assessment, planning, implementation, and evaluation would have helped to provide the best care for Mr. W. but it was overlooked. The lack of care not rendered is a breached in nursing practice and does not comply with the NHS Constitution which states ‘Everyone counts’. Throughout Mr. W’s stay in the hospital, the 6Cs which are care, compassion, competence, communication, courage, and commitment that stands for professional responsibility to constantly render high-quality care as well as putting the individual being thought about at the core of the attention they receive was totally ignored. The code: professional standards of practice and behaviour put forward that nurses should take care of persons as individuals and promote their morality, treat them with courtesy, integrity, and empathy the reverse was the case while Mr. W was bedridden at the St Peter’s Hospital as the guide was not followed while given him care. Another error found is that Mr. W daughter’s suggestion for her dad to receive intravenous fluid was not considered because the doctor and trust staff primary concern were to see Mr. W quit the hospital despite not fully recovered because they want the bed to be free over Christmas. According to the principles of the Care act (2014), any assigned persons who can aid can lend a helping hand with choices in the defenseless adult’s interest. In this report, it is obvious that Mr. W’s daughter is acting in the best interest of her dad taking a look at his past medical history of advanced dementia and depression. The mental capacity acts promulgated in (2005) put forward that a help rendered, alternately choice made, under this act to or for sake of an individual who fails to offer ability must be done, or made, over his/ her best interests.

A further error established from the outline is that despite a drop in Mr. W’s weight of 6st 7 Ibs, the doctor did not see the need for him to be fed through a percutaneous endoscopic gastrostomy(PEG) although contemplated but was disregarded because the doctor said there is a high danger accompanying feeding advanced dementia persons with PEG feeding. PEG feeding advance into a standard low-threat technique in current practice. National Institute of Health (2010) put forward that scientific proof supporting the utilisation of tube feedings in persons with advanced dementia is distinctly unavailable, nonetheless, PEG techniques are still being performed in an exceedingly sizable amount of these cases. Numerous research has revealed that to give food with tubes seldom are essential in enhancing nourishment, retaining skin decency by increasing protein consumption, averting bronchial pneumonia, reducing distress, boosting functional state or extending living. The decision-making procedure is complex, though, also involves the practitioner considering concerns as advance directives, moral issues, lawful/monetary issues, psychological factors, ethnic background, spiritual beliefs, and the need for a family meeting incorporating all these principles. If proper evaluation of Mr. W’s condition was done; the doctor would have reflected on the purpose he was admitted which is due to recurrent dehydration and through research, he would have been aware that a common problem with persons with dementia is poor appetite and dysphagia and that Mr. W was at risk of malnutrition which was obvious as seen by a fall in his weight hence the need for enteral or parenteral nutrition which was administered to him at another hospital where he was nursed for serious depletion of bodily fluid and pneumonia that later regenerate him. This lack of negligence of care by the practitioners poses a threat to Mr. W’s life. As suggested by Beauchamp and Childress (2012) our act must intend to ‘benefit’ individuals – well-being, welfare, comfort, enhance a man’s capability, elevate the standard of life. They suggested that health practitioners should avert hurt, they should try not to deliver hurt on an individual, not to cause torment or suffering, not to deny individuals and not to put to death (Beneficence/Non-maleficence). The report also affirmed that Mr. W suffered neglect as the doctor was no more active in his treatment and despite not safe for discharge evidence by his extreme weight loss, his insufficient nourishment and dehydration and the occurrence of assumed clostridium difficile (a severe hospital-acquired disease), the Trust still went ahead to discharge him without a formal assessment to ascertain whether he is fit or not, neither did they follow their procedure/ national recommendations, nor did they communicate with his relatives. In relation to neglect, neglect can have intense aftermath on elderly persons and should not be underrated. There is a contrast between a preferred style of behaviour and neglect by persons that makes the situations and state of health of elderly people to deteriorate. Therefore, if aged persons suffer malnutrition and dehydration or their medical conditions are not treated, they are said to be suffering from neglect.

As stipulated by Elizabeth (2016), Successful communication with patients, their relatives, colleagues, and other health care practitioners participating in patient’s care is an important base of productive health care. This view is further buttressed by the National Institute of Health (2014), which states that to attain this, nurses must comprehend and render help to clients, by showing respect, kind-heartedness and trustworthiness.

Now, what?

Having gone through the report presented to the Ombudsman by Mr. W’s daughter, it is right to correct all the failings found in other to promote the good nursing practice and to abide by the legitimate, professional and moral principles that underpin the nursing profession and by doing this, personal and professional prerequisite such as communication skills, compassion in care, respect and empathy etc. in relation to the Nursing and Midwifery Council regulations, standards and guidance will be developed. Inadequate nutrition and hydration due to lack of care, failure to communicate patient’s discharge to his relatives, no patient review and failure to follow trust approach on discharge, appear to be the main issues in the above review which are key elements in patient’s care. The need for nurses to keep up with the nutritional and hydration state of patients has been particularly mentioned within the Nursing and Midwifery code of (2015) which was not clearly pointed out in the former version. This is due to previous flaws in the negligence of care at the Mid Staffordshire Foundation Trust where unsuitable food was given to service users without considering their conditions, fluid intake not examined, nor patient encouraged to drink, absence and incorrect documentation of fluid stability and food intake and no water by patient’s bedside etc. Nutrition and hydration is a vital component in the health of elderly persons and has an effect in the aging process. Studies have shown that undernutrition is not uncommon in the UK, involving approximately three million persons at any given time. Therefore, while in practice effort will be made to see that patients are well nourished and hydrated by providing them with their choice of food and drink. Patient that cannot help themselves will be assisted to eat while promoting independence and maintaining patient’s dignity. Assessment to detect and treat those at risk will be done and with the aid of the Universal Screening Tool (MUST) this will be achieved. Hence, patient-focused care and patient preferences will be strictly followed thereby promoting patient’s safety which is the bedrock of high standard health care. Food and fluid chart will always be recorded daily as this will help to identify a patient who is at risk of malnutrition and dehydration, as there was no clear evidence of record keeping in the case of Mr. W. As suggested by NMC (2015), all happenings relating to practice should be documented immediately in a clear and exact way. The daily fluid intake of all patient will be adhered to, water will always be by patient’s bedside, patients will be given fluid at frequent interval throughout the day, support with a special cup will be offered if required. As communication is an essential skill in building up a therapeutic relationship in healthcare, while in practice, all patient’s needs will be communicated clearly to them in simple tense they would understand and any change in treatment regime will be made known. Family members, carers and other multidisciplinary team concerned with patient’s care will also be informed about the discharge plan. This was a failing in the case of Mr. W. as no discharge plan was put in place, other health care practitioners (MDT) were not consulted to review his case before discharge. If this was done and proper care was given, Mr. W would not have been readmitted to another hospital. Nursing Times (N. D) propose that successful discharge arrangement is a requisite to the continuity of care.

Lastly, a good understanding of hospital policies and being conversant with them will be compiled to while discharging a patient so as not to repeat the error made as seen in Mr. W’s occurrence.

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GradesFixer. (2020). Evaluating Personal And Professional Development Requirements In Relation To The NMC Regulation, Standards And Guidance Using A Service User Encounter. Retrived from https://gradesfixer.com/free-essay-examples/evaluating-personal-and-professional-development-requirements-in-relation-to-the-nmc-regulation-standards-and-guidance-using-a-service-user-encounter/
GradesFixer. "Evaluating Personal And Professional Development Requirements In Relation To The NMC Regulation, Standards And Guidance Using A Service User Encounter." GradesFixer, 14 Jun. 2020, https://gradesfixer.com/free-essay-examples/evaluating-personal-and-professional-development-requirements-in-relation-to-the-nmc-regulation-standards-and-guidance-using-a-service-user-encounter/
GradesFixer, 2020. Evaluating Personal And Professional Development Requirements In Relation To The NMC Regulation, Standards And Guidance Using A Service User Encounter. [online] Available at: <https://gradesfixer.com/free-essay-examples/evaluating-personal-and-professional-development-requirements-in-relation-to-the-nmc-regulation-standards-and-guidance-using-a-service-user-encounter/> [Accessed 20 September 2020].
GradesFixer. Evaluating Personal And Professional Development Requirements In Relation To The NMC Regulation, Standards And Guidance Using A Service User Encounter [Internet]. GradesFixer; 2020 [cited 2020 Jun 14]. Available from: https://gradesfixer.com/free-essay-examples/evaluating-personal-and-professional-development-requirements-in-relation-to-the-nmc-regulation-standards-and-guidance-using-a-service-user-encounter/
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