Caring and Professional Nursing Practice

The student nurse will focus their caste study on a patient referred to as Patient A, the student nurse has cared for this patient on a general hospital ward. The purpose of this case study is to demonstrate how the student nurse will deliver care based upon their understanding of the essential skills clusters. In addition to this, the student nurse will highlight the importance of safeguarding and vulnerability in relation to Patient A. Alongside this, any relevant theory with relation to delivering safe care for Patient A will be explained. To ensure consent and confidentiality has been maintained the student nurse has gained informed consent from Patient A witnessed by the practice mentor. This case study will adhere to the policies of consent and confidentiality set by Teesside University, Health and Social Care department, meaning no individuals or services will be named (Teesside University, 2019). Nurses have a duty to safeguard their patients by ensuring that consent and confidentiality is maintained (NMC, 2015).

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There are five essential skills clusters: care, compassion and communication, organisational aspects of care, infection prevention and control, nutrition and fluid management and medicines management. The essential skills clusters were created by the NMC to support student with their learning on placement. This had been brought in due to suggestions that newly qualified were not competent enough. From this change in the programme students have provided a higher level of care and evidently become competent nurses with more knowledge on all the aspects covered by the clusters (Childs, Coles and Marjoram, 2009).

As soon as a patient is admitted to hospital or any other health care setting they are seen as vulnerable this is due to them being having the inability of looking after themselves. The cause of this can be a disability, physical health, mental health or age. Vulnerability also means being unable to protect him or herself against any exploitation or harm (Department of Health, 2000). Nurses should be aware when looking after vulnerable patients and ensure they are as safe as possible to prevent any safeguarding issues from arising (Hocking, 2016).

Safeguarding is acting in someone’s best interest, this individual may require or receiving health and social care (Peate and Potterton, 2013). Another definition of safeguarding is maintaining a humans fundamental right to be safe. This means protecting patient and their families from any harm this can be abuse and neglect or receiving poor practice (NMC, 2010). It is every health and social care professional’s responsibility to safeguard. The main aim of safeguarding is to protect those who are vulnerable and prevent any harm from occurring to them. It is important to support individuals who are vulnerable to involve them in their safeguarding decisions. Also, to raise awareness so that health and social care professionals can work together to identify and prevent any abuse or neglect from occurring (Northway and Jenkins, 2017). Safeguarding can include whistle blowing, this is a process in which health and social care professionals raise any concerns with a member of authority either in or out of the workplace. These concerns will then be dealt with in an appropriate manner which could include suspending members of staff or removing an individual to a safer area (Peate and Potterton, 2013).

This case study is based upon a 21 year old female who has been admitted in hospital due to an overdose. Patient A suffers with mental health problems which include depression, anxiety and post-traumatic stress disorder (PTSD). She also suffers with physical health conditions which entail anaemia, liver failure and coeliac disease.

The first skills cluster that will be discussed is care, compassion and communication. This skills cluster requires registered nurses to be non-discriminatory, respectful of diversities, culturally competent and ensure that they or anyone else does not harass or exploit the individual. To be culturally competent a nurse must have relevant knowledge, skills and attitudes around culture. This means being respectful and being open to learn about people’s culture, needs and beliefs in order to provide effective care. Nurses should have the ability to demonstrate their understanding on how: culture, religion, spiritual beliefs, gender and sexuality can have an impact on a service user’s illness or disability. This will then allow nurses to promote care that takes into account patient differences (Childs, Coles and Marjoram, 2009).

Communication is a vital skill in health and social care and nurses must use a wide range of communication methods to understand and meet the service user’s needs (Bach and Grant, 2015). Communication is the process in which individuals pass a message to another individual or a group of people, once this message is received it can either be interpreted as intended or misunderstood. This can either trigger a positive or negative response from the individual or group of people (Childs, Coles and Marjoram, 2009). There are four methods of communication: verbal, non-verbal, listening and written. The method used is dependent on the capability of the service user.

Compassionate care is seen as a fundamental element of nursing care. It involves working closely with patients and looking at them holistically rather than a medical condition. It is necessary for nurses to empathise with their patients to understand their thoughts and feelings which will then allow the nurse to reassure the service user in the most appropriate manner. This cluster also involves professional caring which is made up of two elements: instrumental caring and expressive caring. Instrumental caring includes the nurse to have required skills and knowledge. Expressive caring involves the emotional aspects of the relationship. These two elements combined allow the nurse to empathise with the individual and develop a therapeutic relationship (Davison and Williams, 2009).

Whilst caring for patient A the care, compassion and communication skills cluster was met by the student nurse. The student nurse had been informed by fellow nurses that they were struggling to communicate with patient A. The student nurse introduced herself to patient A using the ‘hello my name is’ campaign tool. This tool is a highly suggested way to introduce one another, it is the basis from which the student nurse can begin to build up a rapport with the service user. This campaign promotes compassionate care which involves the student getting to know the service user, which can then allow a therapeutic relationship to develop. This was extremely important when working with patient A as she does suffer with mental health problems and struggled to trust people so it was important to ensure that she felt comfortable and safe (NHS England, 2015).

In order to establish a rapport with patient A the student nurse had to take into account the SURETY tool. To communicate with patients effectively nurses must analyse their body language, facial expressions and posture. These features can suggest how the individual is feeling, when working with patient A the student nurse noticed that she seemed anxious so it was important that the student nurse had approached the patient with empathy. The student nurse chose to sit beside the patient with an appropriate space rather than opposite the patient. These features are mentioned in the SURETY tool, sitting at an angle with appropriate space ensures that the atmosphere does not seem confrontational or uncomfortable. This tool was essential for the student nurse whilst working with patient A as she was already in a vulnerable state due to her ill mental health. Patient A also struggled to open up to other staff members and found it difficult to express how she felt, this again highlights the importance of this tool as it allowed the student nurse to communicate effectively with patient A (Stickley, 2011).

The second skills cluster to be discussed is organisational aspects of care. This skills cluster entails nurses to assess, plan, implement and evaluate (APIE) holistic care provided to the patient in relation to the individual’s needs. This can be done by observing the patient, reviewing records and referrals, collecting data and working as part of a multidisciplinary tea (MDT). In addition, it also requires al nurses to safeguard, protect and support their patients who are in vulnerable situations. This is done by working alongside with other healthcare professionals as a MDT to ensure all service users feel safe and protected in the environment (Bloomfield and Pegram, 2015). The importance of this cluster is to look at service users as a whole rather than a condition or a disease, it is vital to take into account the individual’s social, emotional, physical, psychological, spiritual and economic needs. Providing holistic care allows nurses to provide the best care possible and ensure that all of the patients’ needs are met (Perkins, 2011).

This skills cluster was met by the student nurse. The student nurse had reviewed patient A’s care plan and notes to get a better understanding on her conditions. This allowed the student nurse to find out the best way to communicate and interact with patient A which then supported the student nurse to provide the most effective care. The student nurse had gained an understanding that patient A had not been engaging in conversations due to her anxiety and depression. The most effective way to communicate with a depressed person is to take the patient’s mind of what they are worrying about, so the student nurse introduced herself and spoke about her studies which then led patient A to speak about her own, this then helped to engage patient A and allowed the student nurse to build a therapeutic relationship with patient A. Soon after, patient A opened up about her overdose to the student nurse which then allowed the student nurse to work alongside the nurse, doctors and psychiatrists to ensure that patient A received the most beneficial care by referring her to a mental health ward. This then ensured that patient A was safeguarded and ensured that she was cared for until her health improved and was no longer vulnerable to allow her to take care of herself (Childs, Coles and Marjoram, 2009).

The third skills cluster that will be discussed is infection prevention and control. Every healthcare professionals has the responsibility of ensuring this skills cluster is met. The aim of this cluster is to prevent infections from spreading, which evidentially will maintain patient’s health and safety by preventing conditions from developing or worsening (Childs, Coles and Marjoram, 2009). An infection is an invasion of microorganisms such as bacteria, fungi and viruses that multiply within the body. An infection can remain in the location it started or it can spread through the bloodstream, depending on the infection symptoms may be displayed (Williams, 2017).

As soon as a service user begins to receive any form of health care interventions they become more susceptible to infections due to them already being vulnerable by having an illness or disease. Having an illness or a disease can lower a patient’s immunity further, so it is important that nurses reduce the risks of getting an infection. To ensure risks are reduced as much as possible nurses and other healthcare professionals complete a risk assessment for infection on admission, this is included in patient records. Risks assessments include: hospital environment hygiene, hand hygiene, personal protective equipment (PPE), the safe use and disposal of sharps. Within hospitals there are infection control teams which assess the effectivity of the risks assessments and adjust these if any problems occur (Childs, Coles and Marjoram, 2009).

The student nurse had met the infection prevention and control skills cluster whilst caring for patient A. During patient A’s stay at the hospital the student nurse administered medication on a number of occasions. It was important the student nurse maintained hand hygiene by following the 11 steps of hand-washing set by the World Health Organisation. Ensuring that hand hygiene is maintained is essential as hands are easily contaminated and are one of the most common way of spreading bacteria. As nurses it is our duty of care to ensure that when carrying out procedures we maintain infection prevention at a high level by preventing contamination. The student nurse also ensured that the medication did not make any contact with skin to further reinforce infection prevention (NHS, 2016).

Whilst caring for patient A the student nurse administered injections following the policies for safe practice with sharps. The student nurse maintained hand hygiene by washing her hands thoroughly, then equipped herself with the correct PPE in this case gloves and an apron. The student nurse also maintained aseptic technique (free from microorganisms) by ensuring that the area of the skin the injection was going into was clean. After administering the injection the student nurse covered the needle and safely disposed it in the sharps bin. After the procedure the student nurse thoroughly washed her hands. The importance of safely disposing sharps, hand hygiene, PPE and aseptic technique is to prevent the service users condition or illness from worsening, this is extremely important as they are already vulnerable and as nurses it is our duty to protect the public (Childs, Coles and Marjoram, 2009).

The fourth skills cluster is nutrition and fluid management. Nurses are expected to have a good understanding on the skills required in relation to patient nutrition, this includes dietary and any other factors that contribute to obesity, weight loss, ill health and poor fluid or nutrition intake (NMC, 2007). It is essential that nutrition and fluid management is maintained as it has a big impact on all stages of life including growth and pregnancy. The body needs nutrients to enable cells to carry out processes such as metabolic processes. There are four main food groups that are essential to help maintain nutrition and fluid management these are: protein, fat, carbohydrate and micronutrients (Childs, Coles and Marjoram, 2009).

Maintaining nutrition and fluid management is essential and as nurses it is important to promote a healthy lifestyle. To do this nurses must have an understanding on the nutritional requirements of a healthy patient. During illness patients may lose or gain weight, as nurses it is our responsibility to help service users sustain the correct body mass. This can be done by working alongside dieticians to form diet plans to help lose or gain weight depending on the patient’s condition (NMC, 2007). The eatwell plate is a common and effective way to promote healthy eating. This plate is made up from the five food groups: fruit and vegetables, carbohydrates/starchy foods, protein, milk and dairy foods and fats or sugar. This plate shows the recommended intake of each food group and includes eight tips to support healthy eating (FSA, 2008).

Whilst working with patients to enable them to adjust their diets nurses need to take into account the factors that can influence food intake. Some service users may have cultural issues that influence the types of food they are able to eat such as halal meat, therefore it is important that nurses try to meet their dietary preferences as much as possible, in this case it would be providing halal meat (Childs, Coles and Marjoram, 2009). The student nurse met this skills cluster by meeting patient A’s dietary requirements. Patient A suffers with coeliac disease does not allow her to eat any food that contains gluten. Coeliac disease is a common digestive condition that causes the small intestine to become inflamed leaving it unable to absorb nutrients. This can also present with many symptoms such as: bloating, diarrhoea, abdominal pain and malnutrition. The student nurse acknowledged patient A’s intolerance to gluten and provided alternatives for her during her stay. It was essential that alternatives were found as Patient A was already in a vulnerable state and not having the correct food would lead her to become malnourished and inevitably become even more vulnerable (NHS, 2016).

The final skills cluster that is to be discussed is medicines management. All nurses are required to be competent in medicines management. Nurses must have knowledge on medications this includes on how they work, how they are used and how they are regulated. Medicines are often referred to as drugs that are used to change what is happening in the body, they do this by mimicking the body’s chemicals to trigger a response. Either this or they can antagonise the body’s chemicals which can slow down or stop functions (Childs, Coles and Marjoram, 2009).

Patient A was on a range of medications. The student nurse observed the nurse administer Parvolex which was given intravenously, medications are given intravenously to quicken the effect of them as they go straight to the bloodstream. This was extremely important to patient A’s health as it was used to protect her liver from damage from her overdose (GOV.UK, 2014). Patient A was also prescribed citalopram which is an antidepressant. When administering citalopram it was important to check patient A’s health and if there were any contra-indications. Due to the damage of patient A’s liver she was prescribed 20mg rather than 40mg. Citalopram is taken orally in both tablet and liquid form however patient A had requested tablets to be in liquid forms. Each tablet was equivalent to 10mg and each drop was worth 2.5mg, so it was important for the student nurse to be competent in her drug calculations in order to give the correct amount prescribed which was eight drops. It was important for the student nurse to have an understanding on the possible side effects of this medication and to minimalise them as much as possible, as patient A was already in a vulnerable state and it was important to prevent her health from worsening. Citalopram caused dry mouth for patient A so the student nurse ensured that water and juice was accessible to patient A to reduce the side effect (NHS, 2018).

In conclusion, the essential skills clusters are an effective way to aid student nurses to meet patients’ needs. They also allow student nurses to gain a better understating of their responsibility to safeguard patients. Inevitably, it will allow students to become amazing nurses with a good understanding on all the clusters and the responsibilities of a nurse, and to provide the best care possible.

References

Bach, S., and Grant, A. (2015) Communication & Interpersonal Skills in Nursing. 3rd Edition. Learning matters, pp.7.

Bloomfield, J. and Pegram, A. (2015). Organisational aspects of care. Nursing Standard, [Online] 29(27), pp.35-40. Available at: https://journals.rcni.com/nursing-standard/organisational-aspects-of-care-ns.29.27.35.e9581 [Accessed 18 May 2019].

Childs, L., Coles, L. and Marjoram, B. (2009). Essential Skills Clusters for Nurses. 1st ed. Blackwell Publishing Ltd, pp. Vii, 6, 7, 11, 38, 114, 146-158, 166-170, 201-206.

Davison, N. and Williams, K. (14 September 2009). Compassion in nursing 1: defining, identifying and measuring this essential quality. [Online] Available at: https://www.nursingtimes.net/roles/nurse-managers/compassion-in-nursing-1-defining-identifying-and-measuring-this-essential-quality-/5006242.article [Accessed 11 May 2019].

Department of Health. (20 March 2000). No Secrets: guidance on protecting vulnerable adults in care. [Online] Available at: https://www.gov.uk/government/publications/no-secrets-guidance-on-protecting-vulnerable-adults-in-care [Accessed 10 May 2019].

Food Standards Agency. (2008). The Eatwell Guide. [Online] Available at: https://www.food.gov.uk/business-guidance/the-eatwell-guide [Accessed 11 May 2019].

GOV.UK. (11 December 2014). Treating paracetamol overdose with intravenous acetylcysteine: new guidance. [Online] Available at: https://www.gov.uk/drug-safety-update/treating-paracetamol-overdose-with-intravenous-acetylcysteine-new-guidance [Accessed 22 May 2019].

Hocking, A. (9 December 2016). Safeguarding vulnerable adults. [Online] Available at: https://www.nursinginpractice.com/article/safeguarding-vulnerable-adults [Accessed 10 May 2019].

Kelly, R. (5 September 2018). Principles of Consent – Guidance for Nursing Staff | Royal College of Nursing. [Online] Available at: https://www.rcn.org.uk/news-and-events/blogs/principles-of-consent-guidance-for-nursing-staff [Accessed 27 Apr. 2019].

NHS. (10 December 2018). Citalopram. [Online] Available at: https://www.nhs.uk/medicines/citalopram/ [Accessed 22 May 2019].

NHS. (4 December 2016). Coeliac disease. [Online] Available at: https://www.nhs.uk/conditions/coeliac-disease/ [Accessed 11 May 2019].

NHS. (29 September 2016). How to wash your hands. [Online] Available at: https://www.nhs.uk/live-well/healthy-body/best-way-to-wash-your-hands/ [Accessed 11 May 2019].

NHS England. (2 February 2015). Compassion in care campaign hits new milestone. [Online] Available at: https://www.england.nhs.uk/2015/02/hellomynameis/ [Accessed 11 May 2019].

NMC. (16 September 2010). Standards for pre-registration nursing education. [Online] Available at: https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-pre-registration-nursing-education.pdf [Accessed 10 May 2019].

NMC. (29 January 2015). The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. [Online] Available at: https://www.nmc.org.uk/standards/code/ [Accessed 10 May 2019].

Northway, R. and Jenkins, R. (2017). Safeguarding Adults in Nursing Practice. 2nd ed. SAGE Publications, pp.88, 89.

Peate, I. and Potterton, J. (16 August 2013). Safeguarding vulnerable adults. [Online] Available at: https://www.magonlinelibrary.com/doi/full/10.12968/bjha.2011.5.1.8 [Accessed 10 May 2019].

Perkins, C. (11 September 2011). What is the Definition of Holistic Care? [Online] Available at: https://www.holistichelp.net/blog/what-is-the-definition-of-holistic-care/ [Accessed 18 May 2019].

Stickley, T. (November 2011). Nurse education in practice. [Online] Available at: https://www.sciencedirect.com/science/article/pii/S1471595311000618?via%3Dihub [Accessed 11 May].

Teesside University. (2019). Consent and Confidentiality. [Online] Available at: https://sohsc.tees.ac.uk/sites/practicesupport/index.cfm/general-information/consent-and-confidentiality/ [Accessed 27 Apr. 2019].

William, C. (22 August 2017). Medical definition of Infection. [Online] Available at: https://www.medicinenet.com/script/main/art.asp?articlekey=12923 [Accessed 11 May 2019].

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