Reflection on Principles in Nursing

This essay will discuss and reflect on two principles of nursing practice and relate these to practice experience. The principles of nursing practice tell us what all people can expect from nursing practice, whether they are colleagues, patients, or the families or carers of patients. Nursing is provided by nursing staff, including ward managers (in hospitals) or team members (in the community), specialist nurses, community nurses, health visitors, health care assistants or student nurses. To put it simply, the Principles of Nursing Practice describe what everyone can expect from nursing.

Due to many financial challenges facing the UK which is putting all health care and social care sectors under great financial pressure which indirectly is leading to staff shortage and nurses are working tirelessly under undue pressure to deliver the best care for patients. It is therefore a necessity for all nursing staff to be supported wherever possible. The Principles of Nursing Practice allow that purpose to be achieved and make clear exactly what quality nursing care looks like and provide a framework for supporting the evaluation of care through the development of useful measures.

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There are 8 principles labelled A to H. This essay will focus on Principle D which is where Nurses and nursing staff provide and promote care that puts people at the centre, involves patients, service users, their families and their carers in decisions and helps them make informed choices about their treatment and care and Principle E is where nurses and staff are at the heart of the communication process: they assess ,record and report to treatment and care, handle information sensitively and confidentially, deal with complaints effectively, and are conscientious in reporting the things they are concerned about(RCN ,2010). Consent was obtained from service users and confidentiality maintained regarding patients name and trust details as per NMC, 2008

Principle D will now be discussed. The Nature of healthcare provision is such that decisions made and the treatment and care provided, or withheld may alter the duration and quality of lives of the individuals who experience it (Brooker and Waugh, 2007). RCN (2010) definition of person- centred approach:

• Understand the individual, their aims and expectations in life
• Develop a frame of reference to understand their context (family, community, social and cultural dimensions in their attitudes, values and beliefs)
• Understand their concepts of health and issues

My placement at the community hospital was working in partnership in a collaborative way with patients, healthcare professionals, families and other multidisciplinary team members in the delivery of a person centred care. Goodman and Clemow (2008) defined interprofessional working as that of professionals collaborating to work together more effectively to improve the quality of patient care. The original framework for Person centred Nursing developed by McCormack and McCance (2010) comprised of 4 constructs:

• Prerequisites: which focus on the attribute of nurse and include being professional, competent and committed to the job
• Care environment: which focuses on the context in which cares is delivered and include organizational systems that are supportive and effective staff relationships
• Person-centred process: which focuses on delivery of care through a range of activities and include sharing decision and providing physical needs?
• Outcomes: The central components of the framework are the results of effective personal-centred nursing and it includes satisfaction with care, involvement with care, feeling of well-being and creating a therapeutic environment.

At my placement I was personally involved with a patient who had leg ulcer. This patient was unable to move out of bed hence bed bound. I was involved in her personal care, serving, and performing aseptic wound dressing. At the point where the expected discharge date was due, it was then necessary to hold a family meeting with the patient, her daughter and her partner who has a learning disability as well as with the multidisciplinary team (MDT) members involved in her care. The MDT members were social services, occupational therapist, physiotherapist and I as the student nurse with my mentor. The essence of the meeting was to determine the discharge location for the patient. The social services carried out MCA on the patient’s partner who had a learning disability to check if he could cope with the responsibility of supporting his partner after discharge. The partner’s capability to handle finances was also assessed. The physiotherapist assessed the ability of the patient to weight bear and what kind of equipment could be used for different transfers a home. The occupational therapist had already assessed the property of the patient and felt it needs to be adjusted to suit the needs of her current immobility status. However, setting up with necessary equipment would take some time and patient would need to be in a temporary accommodation till the house is resolved. Patient was also given the choice of moving to a nursing home where she could have a better quality of life in terms of care but paient refused and insisted on going to her own home even though she had been advised of the limitations of care that would be received as she had to manage by herself most times and partner is not allowed to carry out any manual lifting. My mentor and I‘s role at the meeting was to give an overview of the personal care requirements and other emotional, clinical and physiological needs. Throughout the meting the patient was involved in the decision process to ensure that all her needs were met and tailored to her specific requirements. She was satisfied with the final decision and was finally discharged and happy to go back to her newly tailored home with her partner.

It is believed that many nurses experience ‘person centred moments’ that is, particular times in practice when everything seemed to come together and the outcome felt satisfying and rewarding. We all have memories of those moments and stories to tell of their significance to us as nurses- be it a significant event with a patient, an expression of thanks from a family member that made the everydayness of practice seem all worthwhile. Such person centred moments may have trigged the question,’ why can’t it be like this all the time’? Whilst acknowledging that we do not work in a state of utopia and that everyday practice is challenging, often stressful, sometimes chaotic and largely unpredictable.it is important to consider how these person-centred moments can be transformed into ‘person centred cultures of practice where satisfaction, involvement and feeling of well-being are common place. To do this requires a commitment to the on-going development of practice, the attention to rigorous process, the continuous evaluation of person-centred effectiveness and the celebration of successes (McCormack and McCance ,2010)

Principle E will now be discussed. This is the fifth principle of nursing practice and it hinges on subjects of communication, the safety of patients, confidentiality, complaints management and conscientious reporting of concerns. Communication is a part of activities that humans engage in and it is recognised by everyone but only few people can define it satisfactorily (Fiske 2011:1)Human communication is defined as the process of establishing meaning via interactions that are symbolic(Adler and Rodman,2009) Communication emphasises on the process by which information is exchanged between two people or more(Bach & Grant, 2011)The important aim for a nursing staff or any health care practitioner is to ensure that patients are engaged in effective communication (DOH, 2010) Any healthcare practitioner working in any healthcare setting must be able to utilise different types of communication skills in a variety of relationships. Considering the culturally diverse population that we have to deal with as health care professionals it is imperative for communication to be effective and appropriate to the needs of the services users (Koutoukidis, Stainton and Hughso, 2013)

Cross cultural communication poses a lot of problem in the healthcare setting and language barrier is a major issue. I had an instant at my placement where a Chinese lady had problem communicating her needs to us and we had to get her husband in to interpret and he himself was not that fluent but we had to use culturally appropriate methods to obtain and pass on information to deliver person-centred care to the patient. Just recently at placement a group of nursing staff were recruited from Spain to come and work in the UK and trained by my hospital, language barrier was such a big issue as they could not easily express themselves and this posed a problem when they were trying to communicate with patients as well. Fortunately, we were very understanding and so were the patients. The national point of reference for communication makes it mandatory that communication needs be analysed and appropriate methods are used to help patients to communicate effectively. Staffs are also expected to communicate effectively with one another to make sure there is continuity of healthcare for everyone (DOH, 2010a)

The formal aspect of communication involves the documentation, sharing of information during handover, managing complaints and reporting of incidents and concerns. These are the main thrust of Principle E and this becomes important when anything goes wrong

The National Patient Safety Agency (2007) raised concerns about nurses in terms of unclear documentation and lack of confidence in their reporting. I have seen instances at placement where fluid and food charts are not updated and makes it difficult to assess the actual health status of the patient. The most common one that is easily missed out is the stool chart or Bristol stool chart and most patients based on the record are given laxatives to address the issue of constipation when in actual fact they were alright. In some instances, the patients have had to speak for themselves and verbally give an account of their flow which is sometimes contrary to what is documented but for dementia patients, it is unlikely to get any confirmation or information from them hence they can only be treated on what is documented. Excellent record keeping is an important aspect of nursing that is relevant to the delivery of effective safe and effective care and it should not be seen as optional or a form of duty that should be fitted in when time permits. It is a compulsory responsibility (NMC, 2010). Instead of writing notes at the end of a shift and to ensure accurate records were documented, nurses were encouraged to abide by the principle of ‘Do it and Document it’ (Tucker et al2009). Personally on placement, I have found this Do it and Document it helpful as the day goes so quickly with a lot of responsibilities throughout the day and there is the tendency to forget essential information and task done if one needs to wait till the end of the day to document. I have made it a principle to document immediately as I finish a task or a short series of task and not leave it to pile up. At all times I have my jotter with me to document whatever I do at every point of the way and this has proved to be workable and successful. The use of Vitalpac just introduced at my placement where information of patients in terms of ,personal identification details,routine observations and risk assessment data can be recorded in real time,stored immediately and automatically transferred to the hospital server where it can be accessed by relevant professionals in real time has proven to be successful ,cost effective and time saving.

It is important that everyone working as part of a team in the delivery of care for a patient must appreciate the contribution made by each person so that appropriate skills are applied. For any teamwork to be the effective, one of the major tools is unambiguous communication which usually takes place via records than face to face. During placement, whilst working within a multidisciplinary team, it was important to us to make sure that information received from other professional are treated as confidential and only used for the purposes they were given and the patients also understood that some of their information may be accessed by other relevant professional members of the team engaged the in the delivery of person-centred-care. (Chapman and Burnard, 2003)

In 2009, a safety alert report admonishing all healthcare settings to encourage an atmosphere of openness and accountability in reporting safety incidents and having a disposition of apologising and giving an count of what happened was published by NPSA. This theme was also iterated by parliamentary and health Service Ombudsman’s (2010) report on how complaints are handled in NHS in England. The act of apologising and giving full account of what went wrong helps to create distress relief and reassures those complaining that mistakes will not reoccur. I happened to have being informed by a patient’s husband that he was not satisfied that his dementia wife’s bed was lowered to the ground as he felt that could have increased her confusion. Even though the night staff lowered the bed in order to prevent the patient from climbing out of the bed overnight as she made few attempts, the patient’s risk had to be reassessed and later admitted that the patient ‘s bed could have been raised back up. We tried to explain to the husband the basis of actions taken, apologised and adjusted the bed back up. He also noticed that her food chart was not updated at breakfast on her chart; this was immediately updated as patient was not alert enough to eat. As soon as I noticed this series of complaints I took it upon myself to pay extra attention to this patient while on my early shift and this paid off in the end as I supported the husband in encouraging the wife to eat, assisted with personal care and undertook her hourly observations to restore her blood sugar level as it was very low. I informed the nurse in charge of the patients decline in health status and intervention was initiated and her blood level was regularised. The husband left for home that day happier than he came in and was very thankful for my assistance.