Foundations of Nursing
Personal and Professional Development Requirements in Relation to the NMC code (2015) and Guidance for Students
The purpose of this paper is to explain the guidance on the conduct of students pursuing nursing and midwifery, and describing what is expected of these students, on a personal and professional level only to be given the go-ahead to practice. NMC (2015) explains that the guidance is based on the standards described in the professional code of conduct for qualified nurses and midwives. The students must follow the code after registering with the NMC when they graduate. They will be striving to achieve these standards after the registration with the NMC.
The plan is to use Burton’s Model of Reflection to explain the development requirements in this paper. This model is important because it does not concentrate on what has happened just once or one incident, rather, it focuses on the reflection on the learning and development someone has gained in the past year. This is important in nursing because a nurse will need the experience to learn how to deal with incidences that might come up during practice. Mclean (2013) provides a case study of Mrs. R that I will explore to provide evidence that supports my claims.
WHAT: MRS. R’S STORY
Mrs. R lived with her husband whom she depended on to help her walk due to her limited mobility. She was taken to Southampton University Hospitals NHS Trust on March 2007 and was admitted due to her deteriorating mobility, confusion and falling repeatedly. The following month she was diagnosed with dementia. Due to her worsening condition, she was given assisted care until she died in July 2007.
Realizing the failings of the nursing care when her mother was in the hospital, her daughter complained to the Trust and then to the Ombudsman. Her first complaint was that during the 13 weeks that her mother was admitted, the staff had not bathed her and when she tried to bath her she was left in a bathroom with neither the help of the staff nor being shown how to use the hoist. This showed the nurses’ ignorance and laziness in their nursing duty.
Another complaint was that the daughter had to ask the staff four times repeatedly to dress an open wound on her mother’s leg. She said that when she complained to the staff she was informed that there was a complaints department. She also complained that the staff did not help her mother to eat, even though her mother could not eat by herself. She said that once this happened when nurses were freely passing time at the nurse’s station. Also, nurses left food trays way too far for the patients to reach and Mrs. R’ s family’s opinion was that the patient could not eat unless it was given to her. The staffs therefore were incompetent and showed poor customer care.
The daughter also said that her mother had fallen four times in the hospital, which includes two falls in 24 hours and when her family requested cot sides for her mother, the hospital refused to say that the use of cots might jeopardize the rights of her mother. As a result of one fall, Mrs. R’s was injured on the face leaving a big mark. Ombudsman (2011) explains how this caused a lot of pain to her family during body viewing. Vividly, the staffs lacked proper communication method to deliver their messages to clients effectively. During body viewing the father could not bear watching the scar on his wife’s face. Shortly after she was buried, the father died.
An investigation done by Ombudsman showed that Mrs. R had nine falls in the hospital instead of the four falls that the daughter thought she had had. Only one fall was recorded in the nursing records. The Identification of Risks of Falls and Intervention Tool were filled only two times and both entries were checked just one time. Nothing showed that the staff kept observing the risk of her falling, no plans on how to care for her, or incident forms filled after her falls. Also, no specialist was consulted regarding the falls. Indeed the nurses were seen as reckless and less passionate.
The investigation found that nothing was done about Mrs. R’s showering, her nutritional needs were not evaluated, and nothing in the nursing records showed that she was given fluids frequently or they encouraged her to drink so as to avoid dehydration. Mrs. R fell nine times in the hospital but the staff only noted one fall in the nursing records this showed their poor record keeping (Wood 2003). The Identification of Risks of Falls and Intervention Tool was only completed twice and the entries reviewed just once and since there was nothing to show that her risks of falling were kept under review, there was also no plans for her care and also, no advice from a falls specialist was evident. The nurses did not help Mrs. R to get the hip protectors, or to put a mattress next to her bed, nor did they push her into drinking lots of water. The wound on her leg was dressed, but it was not clear from the records if it was treated properly. The investigation thus discovered that the nurses neglected their duty causing pain to their clients.
Apologizing to the patient’s family complains, the Trust acknowledged their lack of the facilities to bathe patients and agreed that they could support or offer instructions to families who wished to bathe their relatives. The Trust assured the investigators that they had come up with specific eating times for patients, and also systems to recognize patients who need to be fed. The Trust was sorry that Mrs. R’s daughter had to ask the staff a few times to dress the wound on her mother’s leg.
However, the Trust did not recognize or apologize for failing in other areas like the nutritional needs of Mrs. R and the matter of cot sides. Also, the nurses did not treat Mrs. R effectively. Adie et al (2015), emphasize the importance of wound dressing as it aids in the curative process yet the nurses took too long to do so. The daughter had to request the nurses to dress her mother’s open wound several times. After it was dressed, there was no evidence that the wound was treated properly.The daughter’s complain about dressing her mother’s wound was not addressed. The investigation reported a below standard nursing care given to Mrs. R that led to much pain to her and her family too which could have otherwise been averted. The daughter was not satisfied with how the Trust handled her complains. The explanations and assurances were less satisfying and it was not certain that such incidence will not happen again. She therefore asked for help.
The nursing code consists of professional standards that all registered nurses and midwives in the UK must maintain (NMC, 2015). Patients and their families use the code to provide feedback to professional caregivers on the kind of care they received. It acts as a guide for the nurses, midwives and organizations to make sure they practice safely and effectively while maintaining the standards when providing nursing care (Banks 2009). In addition, Urden et al (2015) assert the code demands prioritizing people, practising effectively, preserving safety, and promoting professionalism and trust.
Ndoro (2014) elucidates that a nurse should show care, compassion, commitment, courage, communicate and work with competence to offer excellent care. Patients should be treated respectfully, and their ethical and human rights should not be violated (Kelly & Innes 2013). The trust did not prioritize Mrs. R needs at all.
The first rule of the code is to treat people individually and maintain their dignity. It is clear that Mrs. R’s dignity was compromised as she had to stay for thirteen weeks without a bath. Another aspect of the code is to listen and respond to the preferences and concerns of the people the nurse is taking care of (Jangland et al., 2009). In the case of Mrs. R, when her daughter decided to bathe her, the staff did not give her any support nor did they offer her instructions on how to use the hoist. The code also states that the needs of the patients should be assessed and responded to, physical, social, or psychological (NMC, 2015). The daughter complaining that the staff did not help her mother to eat even when she could not feed by herself. From these incidences, it is clear that Mrs. R’s needs were completely ignored by the staff at the Trust.
Nurses should confirm patient needs for treatment and should serve with courage and confidence, and when in doubts, always seek advice without delays (Fealy 2004). Dougherty and Lister (2007) advices that nurses should communicate effectively with the patient and their family members about everything they should know and record everything clearly and accurately and pass on their skills, knowledge, and experience when needed. I should also think about and respond to every feedback I get so as to do better next time. I will do this by ensuring that all my information to my patients and their families is true and can be proven. As Stevens (2013); Act, M.C (2005) explains, in the case of Mrs. R, when her family requested the staff to use cot sides, the need to observe the MCA was necessary before making a decision. RCN (2008) states that clear language which everyone can understand, correct means of communication and assisting those who need help to communicate their needs is essential.
A nurse should work cooperatively with his or her colleagues by respecting their skills and ensuring good terms with them (Olshansky 2011). Maintaining proper communication and passing on information helps to find and reduce risks and also promote teamwork (NMC, 2009). I should also maintain my practice records clear and accurate by completing the records as soon as an event occurs and identifying any problems and the plan to deal with them so that anyone else who looks at the records will know what needs to be done. Using Mrs. R as an example, falls were not recorded as soon as they happened, and not all her falls were recorded and there were no plans on how to proceed with her treatment to help her.
Working only on the fields I am competent in and reporting immediately whenever I see something that might endanger the patients or the public. Patients and public’s safety can only be achieved by recognizing and working within the limits of the staff competence (Chadwick & Gallagher, 2016). To do this, I have to assess whether my patients are getting better or worse, referring my patients to the specialists if they need better care than I can provide, and ask for help if the needs of my patients are beyond what I can do.
Another way is by being honest to service users about everything that concerns care and treatment, including when mistakes happen. It is the nurse’s duty to act immediately to right a situation, explain what happened and the possible outcomes, apologize where necessary, record such incidences and find out what can be done to prevent it from happening again in the future (Gregory et al. 2014). Mrs. R fell nine times but the family only knew of two times, and the recording was not done correctly.
I should maintain the exemplary reputation of my profession all the time. NMC (2015) explains the need to always be committed to the standards of practice and behaviour as stipulated in the code to gain the patients, the public, and other healthcare professionals trust and confidence.
From the story of Mrs. R, we see the kind of care standard she received was very poor as the staff at the trust did not follow the code of practice on more than one occasion. Consequently, the family suffered and probably the low standards and neglect shortened her life. Patient’s worsening condition may traumatize their spouse resulting in their death shortly after the patient death (Salminen-Tuomaala et al. 2013). Dewar et al (2010); Firth-Cozens &Cornwell (2009) explains that a different story of maybe a prolonged life is possible if compassionate nursing care is given to the patients and their families. Nurses should treat patients with care and maintain a caring behaviour ensuring the patient’s cleanness and helping them feed when necessary (Catlett& Lovan 2011); this in return will improve the patients health status.
Nurses have a responsibility to take good care of the patients in the hospitals. As a passionate nurse, I would treat her wound as soon as it appeared and dress it appropriately. Treatment offered should be recorded in the nursing record so as to show the kind of treatment that was given to the patients. Mrs. R fell nine times, and something should have been done other than hiding the number of times she had fallen. A specialist should have been consulted to explain the situation and treat her to prevent it from happening so many times. I would also communicate clearly about her falls; record the number of times and the type of treatment plan that the patient needed. Her safety and well being was less preserved. I could have bathed my patient or assist her daughter to do so.
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