NURSING

  An 82-year-old Arnold (grandpa) was diagnosed with dementia at an age of 76. Dementia is a chronic disorder of the mental processes due to brain disease or an injury. Some of the characteristics of dementia are memory loss, change in personality, impaired reasoning, and communication difficulties. Additionally, dementia develops with time causing a decline in someone's abilities to do some activities as before (NICE, 2018). After the death of his wife, the main care provider, his daughter took over the role. Furthermore, Arnold receives care visits twice a week from the district nurses for the dressing of his leg laceration. Recently, Arnold's grandson reported that his grandpa gave his wife's watch to the nurse who came to dress his wound previously. On the other hand, this nurse also heard from Arnold something related which was Arnold admits gifting the watch to the nurse but this time it was his.

This essay will address issues relating to being an accountable professional in the four fields of nursing using the theme of "practice effectively" using communication clearly and work cooperatively as the standards. By use of Arnold's scenario as the case study, the essay will explore the personal and professional values required for an accountable nurse as well as assessing the value of evidence-based in nursing practice. The above-named theme and standards, The code 4Ps (NMC 2018), will be used to discuss the professional knowledge, value, and characteristics in delivery of evidence-based care to the "grandpa".

Communicate clearly will explore why the use of verbal and non-verbal communication is important, recognizing professional misconducts and understanding dementia & what the Mental Capacity Act is. On the other angle, work co-operatively will be used to explore why inter-professional working is vital when giving high-quality care, whistleblowing procedures, reporting abuse if it occurs and how continuous training & development makes a good nurse. Taking into account this scenario, this essay will try to figure out the importance of supporting staff at work and how it impacts the patient(s).

To begin with, the standard "communicate clearly" (NMC 2018) is important when taking care of Grandpa.  Good communication skills help in getting a message across to someone who has dementia, how it meets the needs of an individual by different types of verbal and non-verbal communication. It is important to communicate effectively when sharing information between the health care professional and the patient so that they can understand what is happening with their health (Northway, Jenkins, 2017). Effective communication includes having a good, clear, and tone of voice. "Those skills will influence how a person responds" (McCabe and Timmins, 2013). By paraphrasing or repeating a sentence, it could make Arnold understand and not get confused. By using verbal communication Arnold can express his feelings and emotions. There are certain ways to communicate with Arnold such as using short sentences, "speaking to them slowly, letting the patient respond in their own time as well as holding short regular conversations just in case they feel tired of answering all the questions at once" (Alzheimer's Society 2021). Communicating with Arnold should not be rushed and should be considered confidential, as he may tell something vital which may affect his quality of life. This approach will increase trust and will communicate vital information. (Roberts, 2013).

Communicating non-verbally by using the "SOLER model which was made by Egan (1975) was an aid in teaching and learning about non-verbal communication" (Stickley. T 2011, p.395-398). S= "Sit squarely", which means sitting in a position facing him directly, shows politeness, O= "Open posture" is used when sitting without crossing the arm which looks like a person is ready to listen". L= "Lean forward" and E= "Eye contact", indicates that a nurse is interested in the patient's matter, finally R= "Relax" meaning that a person is not rushing, they are ready to listen (Stickley. T 2011, p.395-398). This model shows how to actively listen to an individual, in addition, it shows better listening skills. SURETY model (which is like the SOLAR model) but only differs in that "it allows for cultural variations and appropriate use of touch" (Stickley. T 2011, p.395-398). This means that a nurse should bear in mind a person's background as different cultures have different ways of interpreting the use of touch as they may find it uncomfortable and which distresses them (Alzheimer's society, 2021).  Fundamentally, this model helps a healthcare professional to think about therapeutic space when using non-verbal communication methods, to make a patient feel at ease. (Ausmed, 2019).

Furthermore, in this case, study the incident which took place is a type of financial abuse. A nurse needs to use active listening skills to find more information to report to senior members. "All nurses should refuse all but the most trivial gifts" (NMC CODE section 21.1, 2020). This shows the nursing staff has shown little respect or dignity towards Arnold, which is against the NMC codes. The Royal College of Nursing (RCN 2021) suggests that one of the values and attributes of a nurse is to be vigilant about the risk and help to keep patients safe. In general, the mental capacity act protects people's right to decide. This act lets patients make their own decisions or it could be the healthcare professional supporting the patient to decide on their behalf in their best interest (Mental capacity act 2005). In addition, Arnold having dementia does not mean he cannot decide for himself. One of the principles of the mental capacity act is the assumption that a person has capacity unless it has been proven that they lack capacity (Carers UK, 2014).  Alzheimer's disease is the most common type of dementia, the signs and symptoms involve problems with memory loss such as forgetting recent events while remembering distant memories. Furthermore, dementia affects communication such as having a long conversation. Studies show that an estimated 5.0 million people had dementia in 2014 and the figure is increasing every year (Centers for disease control and prevention, 2019). The capacity assessment could help check whether a health care professional should act in the patient's best interest. "The holistic approach to best interest ensures that the wishes of the patients and views of those caring for the patient are taken into account" (Griffith and Tenghnah 2020, p.124).

Similarly, ethics are important in the workplace as nursing staff needs to recognize problems and make decisions based on their beliefs while following the codes of conduct (Haddad et al, 2021).  Respect for autonomy suggests professionals should respect what they say and listen to them instead of assumptions. Also understand what has been told to them, respecting their privacy, and protecting confidential information to reduce the risk of harm (Northway and Jenkins, 2017).

In addition, the Principle of non-maleficence as nurses should keep patients and others safe by reporting incidents that are told by patients who may lack capacity. Reporting minimizes the risk of repeated offenses. Nurses should listen to the story told by the patient and also let them know that it will be shared with professionals in the patient's best interest. Ignoring those issues could make things worse. "It is about making sure benefit to the patient over harm" (Northway and Jenkins, p.50-51). An example of this principle is preventing carelessness; a nurse should report concerns as not reporting will maximize the risk of harm (Rosenberg, 2020).

Furthermore, the Principle of beneficious; active listening, being competent such as being educated in the field of nursing as well as being professional such as holding Arnold's hands and empathizing with him will make Arnold feel safe and may speak out more truthfully. In addition, "nursing care should be the assistance of the patient, also nurses should respect an individual's independence" (Griffith and Tengnah 2020, p.42-43).

Lastly, in Principles of justice, "both parties need to be listened to, as nurses, they need to treat their statement fair" (Griffith and Tengnah, 2020).  Their statement should be listened to and responded to correspondingly. "The Equality Act 2010 suggests that it is unlawful to discriminate against a person because of their certain characteristics such as age and having a disability" (Griffith and Tengnah, 2020). Both statements need to be reported to get a fair outcome. In addition, to maintain trust and respect from the patient a nurse should be following the professional standards (Davis et al, 2014).

If professional misconduct arises, the nurse should inform the patient, it is a "duty of candor to report the situation to the relevant people such as safeguarding team" (Griffiths and Tengnah 2020, p.62-63). In addition, a nurse should also explain the long-term and short-term effects on their care due to misconduct "Professionals should be honest with patients when something goes wrong with providing care such as financial abuse" (Nursing & Midwifery Council, 2019). RCN (2021) suggests that nurses should take responsibility for the care they provide and answer for their actions, however, it should be done by following the laws and the code of conduct.

On the other hand, working together develops clinical performance, enhances patients experience, and better care planning (Social care institute for excellence, 2018). To meet the needs of the individuals it is crucial to work together in multi-disciplinary teams. "In the Crimean War, Florence has worked as a team to secure access to good quality supplies of food and water" (R. Williamson, Jenkinson, and Proctor-Childs, 2010). RCN (2021) suggests that working as a team to make sure patients' care is coordinated gives high standards of care which leads to an improved outcome.

When sharing information with other healthcare professionals working together to evaluate the potential risk Arnold is in and how to make him safer next time, verbal or written consent is needed from him or the advocate who is acting on his behalf. "Sharing the right information at the right time is good practice in safeguarding adults" (Social care institute for excellence, 2015). There may be several healthcare professionals involved in Arnold's care to provide holistic care. The NMC (2015a) code states that "information about a patient should be shared appropriately and inform the patient about their care". Whistleblowing policy at the workplace for example, if any harm or abuse is seen or heard it must be reported to the seniors. Arnold may also be susceptible to all types of abuse whether it's physical or psychological because of his condition. By following guidelines protects them from abuse and misconduct (Northway and Jenkins, 2017). Furthermore, when carrying out daily activities, professionals should gain consent regularly as patients have the right to know what is happening with their care.

Continuing professional development (CPD) is essential within healthcare as policies and procedures and legislations are changing every day as well as how we care for the patients is constantly changing. CPD with up-to-date knowledge contributes to improved patients' outcomes and increased public confidence (Royal College of nursing, 2018).  Self-reflection is also important in implementing the care of Arnold, as it is a good way to think about what went well and what could improve. It allows one to recognize own strength, develop self-directed learning, and also enhances the quality of life that will be given. Nurses must complete a degree program including doing experiences and theoretical modules to enable them to qualify as a registered nurse (R. Williamson, Jenkinson, and Proctor-Childs, 2010). This leads to registration with the nursing and midwifery council (NMC) in any branch including health visiting, "these origins back to the 19th century when Florence established nursing school" (R. Williamson, Jenkinson, and Proctor-Childs, 2010). "Nightingale developed her ideas regarding the need for nurse training as well as improvement of the hospital services" (R. Williamson, Jenkinson, and Proctor-Childs, 2010). Fundamentally her approach still contributes today directly to standards of care as well as improving the status of nurses with education and training in place.

Supporting colleagues at work such as promoting health and well-being, which relaxes stress of the workload, making a colleague feel valued and supported makes them perform good standards of work. In addition, if there are any errors or health issues a nurse should be accountable for what they do and dare to let their senior know. By providing more training and education to staff influences the way care is provided which response to patient's needs (RCN, 2021).

In conclusion, while giving care to Arnold it's required to consider the professional knowledge a nurse holds such as the codes of conduct, they are the guidelines for nurses to provide holistic care to the patient. Having awareness of laws and research enables nurses to give more up-to-date care to the patient. Improving personal and professional development is important as it helps to give improved quality of life as caring for the patient is changing rapidly. Practice in line with current evidence-based practice as everything a nurse does should be backed up by research evidence. Nurses should be compassionate and caring, respecting patient's wishes and promotes dignity. In addition, not making assumption around lacking capacity when a patient report concerns and sharing them with different professionals. Therefore, to tackle safeguarding issues or any concerns it is better to work together with a multi-disciplinary team to tackle the risk of abuse in the future while maintaining confidentiality. From the above discussion, it is clear that some of the principles supporting professional knowledge are: the principle of non-maleficence, beneficious, and justice. Being respectful, trustworthy, truthful, ethical conduct, improved communication skills among others are seen to be values and attributes of being an accountable professional.

 

 

 

 

 

 

 

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