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Delivering Patient Care: A Case Study Essay

Delivering patient care is intertwined with communication and person centred care. It entails understanding that healthcare professionals put patient’s needs at the centre of the whole process of their care. However, care is achieved by providing patients with the best treatment for their illness, give them the choice of treatment, respect their decision making and maintain confidentiality of their information (NMC, 2010). My observations during practical placement in care of the elderly ward in Kent led to the understanding of two significant nursing principles.

The name of the hospital and the trust shall not be disclosed in this essay, however a pseudonym will be used to discuss the patient with whom I had an encounter. In both instances, consent was obtained and confidentiality was maintained regarding patient name and details (NMC, 2015). Nursing principles in general have great importance in everyone’s life, from the nursing staff to the patient. The principles of nursing practice provide clarity to patients and their families and proves to be a guideline of what to expect from nursing care regardless of the kind of nurse who implements these principles.

That is why these principles have been developed as a medium of instruction for the nursing staff and the public so effective patient care could be provided (www2. rcn. org. uk, 2017). This essay will focus on Principle D, which is based on patient person centred care and Principle E, which encompasses communication. Person centred care can be defined as the process by which healthcare professionals work collaboratively with individuals using their services.

This is achieved when care is coordinated and tailored to the needs of the individuals, underpinned by dignity, compassion and respect which enables them to live a fulfilling life (Health Foundation, 2014). Nursing practices without a patient-centred model of care would be insufficient and less effective. Communication is another important practice of nurses for without the ability to sufficiently communicate the health care plan or guidelines to the patient, and without understanding patient’s needs, nursing is incomplete.

Communication thus is one of human’s every day activity that everyone recognises, but few can satisfactorily define (Fiske et al. , 2010). Everyday life and nursing care cannot be effective without communication. Communicating effectively is the key determinant for patient satisfaction, recovery and compliance (Chant et al. 2002, p. 13). Poor communication is regarded as one of the most common causes of complaints in healthcare (Cambell, 2008). In nursing, communication generally entails sharing of health-related information with the patient and his/her family.

The information shared could be verbal or non-verbal, written or spoken, personal or impersonal, issue- specific or even relationship orientated (Sheldon, 2004:4). Person centred care though vital to nursing care cannot be achieved without effective communication. Nursing staff uses the process of communication for patient care, assessment as well as reporting and recording treatment measures. Handling sensitive information and maintaining confidentiality is another important part of their job.

Moreover, they also have the responsibility of dealing with complaints effectively and reporting any negative issues related to patient care (NMC, 2016). According to the Nursing and Midwifery Council’s code of conduct, patient confidentiality must be maintained always (NMC, 2010). Consequently, I will discuss what I observed on placement with Mr. Smith, who consented to sharing the details of his care in the hospital. Mr. Smith, was admitted to the care of the elderly ward, diagnosed with increased confusion, community-acquired pneumonia (CAP) and falls.

He is a 70-year-old male, was a football coach and had an active lifestyle prior to his illness. He is married with three sons and seven grandchildren and according to his wife, a good and loving father to his children in all instances. I was presented with the opportunity to see Mr. Smith’s admittance in the ward and the care he received at the hands of the nursing staff in due course. But the process of care requires finding a solution that has the consent of the patient and fulfils all his needs effectively.

Nurses should work with the patients to understand their needs and communicate those needs to the respective physician through model like Situation, Background, Assessment, Recommendation (SBAR) so that no treatment protocols are overlooked and patient gets the best treatment possible (Jointcommission. org, 2017). Nurses are responsible for not breaching patient’s confidentiality, and to treat them with dignity and respect because that would be considered good nursing practice (NMC, 2010). On admission, I introduced myself by communicating clearly and effectively with the patient and his family members.

I employed both verbal and non-verbal methods of communication. The former for the benefit of the patient and the family in which I clarified what my next action would be and how I would carry out the task. Moreover, it is necessary for a nurse to appear calm, honest and straightforward to ease the discomfort of the patient and to reassure the family members. Furthermore, verbal communication was also required to acquire the consent of patient and his family so I could proceed with my evaluation because the hospital policy requires us to do so.

The documentation was done for the benefit of the patient and involved gestures and maintain eye contact with the patient. Because of the age of the patient and his dementia I wanted to make sure that my actions were understood by him and he would not feel any discomfort during observations (Lucas, 2015). Only after effectively communicating, did I proceed with the task of checking his vital signs, BMI and MUST score, making sure his pressure areas were intact (Maguire and Pitceathly, 2002). After the initial observation on the patient, I listened to his family’s narrative of how his health had declined prior to his admission in hospital.

All this information was written down so detailed assessment could be given to the assigned doctor. As a student nurse, I acknowledged the limitations of my competence and provided an accurate and honest assessment to my mentor, so she could relate to the multi-disciplinary team in other to recommend a treatment plan soon (NMC, 2015). Using the model of SBAR doctors were informed of patient’s condition. This model is useful for nurses in effective communication as it helps verbalize the problems which can then be communicated to the doctors.

The goal is to receive patient responses that help in identifying a solution to help the patients. The first step is situation where a nurse must introduce herself/himself to the doctor including their name, professional title, work location and the patient under their care. Then, problem is described in detail in which the doctor was told of patient’s symptoms and his complaints. Background entailed communicating patient’s history and specific information related to the patient that could help in their treatment.

For example, Mr. Smith had no family history of dementia. During assessment, his wife stated that he started having difficulties with his mobility, co-ordination and developed slow eating patterns. He also began experiencing memory loss and inability to think or reason. He would muddle up cutlery and sometimes would stare at the food without eating it. Lastly, recommendation comes into play when doctors suggests solutions to the problems. In this case, all his symptoms indicated dementia which caused his family extreme worry (Jointcommission. org, 2017).

Moreover, involvement of the multi-disciplinary team now became a necessity as Alzheimer’s Society UK, has revealed that number of people living with dementia have dramatically risen and are expected to rise to 2 million by 2060 and this called for serious action (Alzheimer’s Society, 2011). By all accounts, SBAR proved to be an effective technique for communicating with all the multi-disciplinary team bringing us one step closer to the patient centred care program we needed for Mr. Smith.

Consequently, the doctors referred Mr. Smith to the physiotherapist and the occupational therapist, so they could assess his mobility and provide him with support and equipment. This is where person centred care comes into effect. Healthcare professionals work together and share information to deliver the best quality of care to the patient (World Health Report, 2006). In this instance, the aim was to help Mr. Smith improve his muscle coordination. During meal time, I observed that Mr. Smith wasn’t eating his lunch. I took a reasonable step by informing my mentor, who made sure he was listed for assisted meal (help with feeding during meal time).

Before assisting Mr. Smith with feeding, I introduced myself and my role to him and asked him what he wishes to be called, doing so helps establish an initial rapport (Silverman et al. 2012). I noticed that he found it hard to swallow his food and coughed every time he drank water. Although, I was limited by my role as a student nurse, I abided by the relevant policies and laws relating to protecting and caring for vulnerable adults and called for a nurse who could help the patient more effectively (NMC Code, 2015).

Acknowledging that the patient needs had to be met, I had to make sure that information relating to Mr. Smith’s care was well documented. For this purpose, I added this new development of problems in the nursing notes so that other healthcare professionals can read the recorded information. Recording and documentation of patient’s information, medical history as well as any changes in their condition is important as it used for future assessment of the problem and for effective means of communicating to healthcare professionals.

Communication again is of great importance because the doctor relies on the nurse’s assessment so that an effective treatment plan meeting all the needs of the patient could be made. These notes or charts are used to keep track of changes in patient’s condition and provide easy consultation for when the patient comes back for a follow-up procedure or a new medical problem. Nurse’s notes are in fact a method of non-verbal communication with the doctor where just by consulting the notes, nurses can effectively communicate updates on the patient.

This is a true example of how principle of communication plays a significant role in ensuring team-work and in appreciating contribution of nurses who pass information accurately to ensure the best patient centred care possible in hospitals (Sheehan et al. , 2007). Next, Mr. Smith was referred to SALT (Speech and language therapist), who came to the ward to assess him. After assessment, he was prescribed puree meals and stage one thickened fluids to help with his chewing, swallowing and dietary needs.

I listened as the speech and language therapist explained how this new feeding regime will help Mr. Smith with his eating difficulties and would prevent decline of his health because that was a big concern at his age. Listening is another key skill of communicating effectively as it requires concentration, and both verbal and non- verbal affirmations (Silverman et al. , 2005). The speech and language therapist recorded her findings on nursing notes so that other health professionals could be made aware of changes in Mr. Smith’s food regime and proceed accordingly.

This was an important task because the speech and language therapist key role is in the assessment and management of disorders/disruptions to the vital functions of the body and any changes in patient’s health must be recorded accurately (Giordana and Clara, 2006). Due to his impaired cognition, the nursing staff reported behavioural problems in Mr. Smith. For example, he would sometimes climb out from his bed, take his clothes off and when approached would become aggressive to the members of the nursing team.

His inability to recall his environment at such times is due to memory lapses which occur with changes in the brain (hippocampus). Hippocampus manages the movement of information from short to long term memory and orientation. Even though, communicating with Mr. Smith was challenging at times, I relied on the circular mode of communication which allowed me to use a soft tone of voice, an open body language and a cheerful facial expression that greatly helped in reassuring him (Dementia UK, 2012).

Having in mind that he was once a football coach, and had an active lifestyle prior to his diagnosis, he may feel a lack of purpose in the environment of the hospital which might contribute to his difficulty in understanding his surroundings. This can be explained by the fact that while before he had a group of people relying on him for advice and coaching, now he just felt helpless and dependent on others for his every need which could add to his mental stress and result in his lashing out. Creating an environment which is conducive to his orientation is important.

Research has shown that non-pharmacological interventions such as socialization and use of psychical and intellectual activities can help manage decline of age and dementia (Ruthirakuhan et al. , 2012). In this regard, we might ask his family members to bring in any memorable belongings or pictures of his coaching days to give him some semblance of normalcy. Similarly, nurses are required to help patients maximize their independence through activity as mobilization is seen to assist with orientation (Neville, 2006). A crucial element of nursing process is planning for the care of the patient.

For this purpose, the nursing team had to write a care plan tailored to the specific needs of Mr. Smith and in compliance with the instructions and records of the dementia nurse. The nursing team had to listen very carefully when he spoke, gave him plenty of time to explain what he wants and reply to his request using either verbal (i. e. written notes) or non-verbal (i. e. picture cards/gestures) methods of communication. Providing a nursing intervention for Mr. Smith, the ward manager provided a one to one nursing staff to take care of him to prevent fallings.

Appropriate communication was established with the family members to increase their involvement in the provision of care for Mr. Smith. Acknowledging that hospitals can be a strange place, it is advisable that the patient be surrounded by familiar faces engaged in various activities with the patient such as, playing indoor games, and even just sitting together during mealtimes would create a positive outcome of his care. His family were given the chance to feel completely involved as much or as little as they wished.

Recognising how distressing the whole ordeal can be for the family members, the doctors called for a best interest meeting where his wife and children were given the opportunity to discuss about his health and how best to manage his condition. They were given advice on where to find further help. Patient safety is a priority and must be observed very carefully to prevent any injury occurring to themselves or others (NMC, 2012). This again is a situation where effective communication is necessary because family is an integral part of patient centred care as ell as recovery and assurance by the doctors can help relieve the stressful situation of the family, leaving them more open to doctor’s and nurses’ advice for patient care. Communication, remains key to understanding the experiences of a person with dementia and the information they are trying to relay. Truth and trust are very clearly linked, and are the basis of forming and maintaining good relationships. Truth telling should remain the starting point in conversations with the patient and his family to ensure quality care (Thompson, 2010).

Person centred care has become a model of health care for dementia patients across the UK. It has become synonymous with good quality care and the new approach in dementia care has claimed to be person centred to be politically correct (Edwards et al. , 2010). Person centred approaches have significantly grown in awareness of dementia in recent years. By understanding this approach to the care and support of people living with dementia, arguably more positive view of dementia has been achieved (Brooker, 2007).

Communicating with his family members helped during Mr. Smith’s transition of care. For example, by understanding what his likes and dislikes were, and how we could maintain a safe and friendly environment. Moreover, to achieve a positive health outcomes, we collaboratively worked with the nursing team and patient’s family to ensure quality care for him. For example, at times when Mr. Smith was having difficulty controlling is anger, any of the nurses in the surrounding area would come to aid even when they were not directly responsible for his care.

Similarly, his family members would sit and have discussion on any of his favourite topics to stimulate his mind and to keep his engaged in everyday life. It is important to bear in mind that patient’s right to privacy and confidentiality must be maintained even when he is incapable of making decisions for himself (NMC, 2010). Patient safety is a priority and must be observed very carefully to prevent any injury occurring to themselves or others and if such a situation arises, ensure family’s involvement (NMC, 2012).

The way patient care is managed in hospitals has changed over time and now centers around multidisciplinary teams working collaboratively together to ensure that patient care is improved and maintained. However, person centered care aims to ensure a person is an equal partner in their healthcare (RCN, 2002). Mr. Smith was an equal partner in his care. He had the choice to decide which activity he wanted to participate in during recreation time, as well as make important decisions for his course of treatment because all of this was crucial to his recovery and required his equal involvement.

Although, part of his intervention was to make him feel independent again. During personal care for instance, before commencing with the procedure, I had to read his care plan, check if he requires any manual handling and risk- assess him to gain knowledge of safe practices. Prior to the procedure, I had to explain and obtain consent from my patient (NMC, 2008). Assisting Mr. Smith with personal hygiene, I had to clear his bed side area of any obstacles, close his room doors and draw curtains to ensure privacy and guarantee dignity because that is required of a nurse (NMC, 2008).

I also used disposable gloves and aprons to minimize risk of cross-infection (Fraise, 2005). Encouraging him in his clothing choices and participating in his own care also gave him some sense of belonging. Through effective communication nurses can maintain a safe environment and promote patient independence (NMC, 2012). But these tasks require some level of communication with the patient and that is why communication and patient centered care are two of the eight principles of nursing practices because without them none of these tasks can be achieved and a patient would be left feeling vulnerable and neglected.

Mr. Smith’s enhanced care needs were reviewed daily by the nursing team to see if increased observation was still needed. As nurses, we must act in partnership with those receiving care by helping them to access relevant health and social care information and support them when they need it. Nursing staff are required to treat a patient with compassion, kindness, dignity and respect (NMC, 2012). Adapting good and right practice is desired over bad and wrong practice, moral practice demands that nurses develop sensitivity to the suffering of others (Armstrong et al. , 2009).

Thus, communication comes into play when essential patient care information is to be imparted. Subsequently, when Mr. Smith was medically fit for discharge, the multidisciplinary team was involved in his discharge plan. The doctors discharged him with to- take- out (TTO) medications which were dispensed by the pharmacist; the physiotherapists made sure his mobility was stable and provided a Zimmer frame to aid his walking; the occupational therapist made sure his living conditions at home were conducive for him and the community liaison team made sure his needs in the community were met.

Package of care was instated to assist his family with support in his own environment and to fulfill all his needs following discharge. The fact that the patient and his family were satisfied with the provided patient centered care shows how effective communication between nurses, doctors and therapists resulted in positive health outcomes for Mr. Smith. This essay has helped me understand that communication and person centered care are vital to goof nursing practices and cannot be neglected in any situation.

Nursing care cannot be effective without communication, whereas patients cannot receive the adequate treatment and care they need without the healthcare professionals working collaboratively together to see that their needs are met. However, there is a need to admit an equal say in all aspects of patient’s their treatment and care. Person centeredness is achieved when care is coordinated and tailored to the needs of the individual, underpinned by dignity, compassion and respect which enables them to live a fulfilled life.

Thus, in achieving these goals and to improve health outcomes, effective communication is a necessity. Both principles of nursing practices have a lasting benefit as is evidenced by my experience during clinical placement. Although nurses and other health care professionals always encounter difficulties in acknowledging patient empowerment as a concept, effective communication helps in patient care, treatment and support to achieve good health care outcomes and as evidenced by research, help promote a good quality of life and enhance staff satisfaction.

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