Ensuring Patient Confidentiality and Dignity

Introduction

The patient scenario of Jones informs that he is 78-year-old individual suffering from dementia with deteriorating health condition due to which he was hospitalised. In hospital, Jones has become more confused and often shouts to get out of his bed and request to see his wife Barbara. He is seen to soil himself each day and has poor personal hygiene which Barbara mentions not being normal as Jones is quite meticulous regarding his hygiene. In the hospital, during care Jones is seen to have lost his denture and have recently experienced fall that led to badly bruise him making Barbara get upset regarding his health condition. According to the NMC Code of Practice, the confidentiality of patients is to be ensured by the nurses during care so that no harm or abuse is experienced by them (NMC, 2018). In this purpose, the pseudonym Jones is to be used for indicating the patient in the assignment so that the real identity of the individual remains confidential.

In patient care, the nurses are responsible to empathetically support the patients and develop collaborative relationship with them to understand their key needs and determine the root cause of their health condition. This is essential to effectively diagnose the health of the individuals and provide appropriate treatment for promoting their health. The nurses are responsible to provide physical as well as emotional care to the patients by following the professional values. This is to ensure ethical and legally approved care practices are established for the patients to ensure their enhanced well-being (Doenges et al. 2019). In this assignment, the case study of Jones is to be reflected by using Driscoll’s reflective model to highlight the professional values to be implemented for the individual’s safe care. In this purpose, the legal and ethical framework useful to provide effective care to the individual is also to be reflected. Moreover, the biological support and intervention required for the individual are also to be reflected.

Professionalism and Reflective Practice in Nursing

The professionalism in nursing is abiding by the set of values which are critical to elevate the care quality for the patients while trying to improve methods, standards and judgements regarding nursing practice each day (Lim and Jo, 2016). The key elements of professionalism in nursing includes compassionate interactions with patients, positive of care, abiding by professional responsibility, executing ethical practice, care integrity and teamwork (Hwang and Shin, 2017). This is because positive care by following responsibility helps the nurses to meet the key aim of their profession that is promote health of patients. Moreover, ethical practice along with compassionate care leads the nurses to develop trust from the patients in delivering them care. The NMC Code of Practice informs the nurses in the UK regarding the actions to be performed during patient care so that professionalism can be ensured (NMC, 2018). As asserted by Yoder (2017), professionalism in nursing practice is important to ensure safety for the patients. This is because it leads nurses to deliver care with commitment and effective responsibility ensuring safeguard of health and well-being of the patient. As criticised by Oh et al. (2017), lack of professionalism in nursing leads to create hindered care atmosphere and efficiency of care for the patients. This is because inappropriate care approach is taken by the nurses along with show lack of commitment in providing care to the patients making their health condition to deteriorate out of negative care environment.

The ethical approaches to be abided by nurses in profession include autonomy, justice, non- maleficence and beneficence (Mohiuddin, 2019). This is because each of the approaches ensures dignity and value of the patient is upheld in the care which is the professional duty of the nurses. In order to maintain effective professionalism in nursing, the nurses are required to execute reflection of their practices. This is because reflection in nursing care helps the nurses to execute self-directed learning in which they are able to determine their personal strength and weakness regarding a situation and the skills along with knowledge to be improved to enhance their quality of care delivery (Reljić et al. 2019). Thus, the reflection regarding nursing care for Jones is to be performed to determine the strength and weakness of the professional values and care in the situation provided by the nurses. Moreover, the reflection would be made to highlight the positive professional values to be implemented for Jones in supporting his safe and enhanced care. The reflection is to be executed by using Driscoll’s Reflection Model that mainly include three stages that are what?, So What? and Now What? (Graham, 2019). The Driscoll’s model is selected for use because it provides benefit to gather quick information by following set of simple questionnaires regarding the strength and limitation of the situation or personal skills of individuals (Smith, 2016).

Driscoll Reflective Model

What?

The section mainly considers describing the key incident of patient care executed by the nurses in healthcare (Graham, 2019). According to the given scenario, the key motive of returning to reflect on the situation was to determine the negative experiences of care for Jones and the reason behind them. This, in turn, would help to identify the appropriate positive professional values to be implemented for Jones in enhancing his care. Moreover, the reflection is made to provide more power to Barbara in supporting the care and discharge of her husband Jones. According to the case study of Jones, it is seen that he was suffering from dementia which deteriorated leading him to get hospitalised. The 6 C’s of nursing mentions that the nurses require to have professional value of being effectively competent in taking care of the patients by understanding their health and social needs (RCN, 2015; Pini et al. 2018). However, in the hospital, it was mentioned in the case that none of the healthcare workers or nurses expressed competence to determine the cause behind what was happening to Jones, in turn, making him face further confusion regarding his health. This is evident as no appropriate care intervention was taken to reduce Jones's raised confusion, controlling his shouting and aggressive behaviour.

According to 6 C’s of nursing, the professional value to be abided by the nurses is delivering effective care to the patients for improving their well-being (NHS England, 2015). However, in Jones case, it was seen that nurses avoided taking appropriate care for him. This is evident as instead of calming Jones and providing him compassionate care to control his confusion and wish to get out of bed, the nurses tried to put up the cot to confine him in bed. Moreover, no care intervention was taken to maintain effective hygiene of Jones, no dentures were replaced so that he can have solid food as liquid diet was often refused by him and no care actions were taken to ensure effective communication with Jones by the nurses to understand his key needs. According to 6 C’s of nursing, nurses are to follow value of compassion according to which they are to deliver compassionate care with empathy to uphold the respect and dignity of the patient (RCN, 2015). As mentioned by Feo and Kitson (2016), maintaining hygienic and clean appearance of the patients act to promote their self-esteem and dignity. However, in case of Jones, the nurses were seen to lack empathy to understand the importance of maintaining hygiene of the patient and expressed no compassionate care to resolve his confused state, in turn, compromising his dignity and respect.

The 6 C's of nursing mentions that nurses are required to have effective professional value to establish successful communication with the patients and colleagues to manage quality care delivery by understanding needs of patients (Chadwick, 2017). In case of Jones, it was seen that the nurses did not follow professional value to develop effective communication. This is evident as when the nurse wrote in the paper to ask Jones to remain quiet and he could not understand as his spectacles were not present, the nurses did not take any other communication approach to make the patient understand her command and develop effective interaction. The 6 C’s of nursing entrust the professional value of courage to be played by the nurses in which they are required to have the stern ability to take actions for executing the right thing for the patient by overcoming concern (Kelly and Tyson, 2016; RCN, 2015). In case of Jones, it was seen that the nurses did not express courage to overcome the concern of not allowing Barbara to remain by the side of Jones which is inappropriate action. This is because dementia patients often develop trust to be cared by their closed family members instead of nurses as they have trust over them (Hao and Ruggiano, 2020). Thus, not allowing Barbara to remain by the side of Jones irrespective of his demand as it would be disruptive for other patients and there is lack of space for her to sit led the nurses show lack of courage to take actions in ensuring better care for Jones by resolving concerns.

The 6 C’s of nursing mentions that professional value of the nurses is to maintain commitment to the patients to improve their health condition and experience regarding care (RCN, 2015). However, this was not followed while caring for Jones. This is evident as nurses show lack of commitment to resolve physical and emotional concern of Jones leading him to expressed intensely deteriorated mental capacity and physical health with lack of hygiene. The case study of Jones also informed that no autonomy was provided to him as he was not allowed to make informed decision regarding his care by the nurses. This is evident as no actions were taken to provide solid food which was decision by the patient after the loss of his dentures. Moreover, he was not allowed to make informed decision regarding the way his care is to be managed with presence of his wife Barbara.

There was lack of beneficence ensured for Jones as the nurses rarely took effective steps to ensure benefit for the patient. This is evident as no effective medication was provided by nurses to improve deteriorating health of Jones, arrange spectacles to help Jones read care instructions, provide supporting actions for prolonged time to avoid fall for Jones and others. The nurses only allocated two guards for few days to protect him from leaving bed and prevent fall but it led to emotional turmoil and fear in Jones that he may evacuated as done during the war. The non-maleficence is to avoid doing any harm to the patients during care (Stewart and Scott, 2018). This value was maintained by the nurse while caring for Jones where they never abused or intended to harm him. However, their hindered and error in care led Jones to experience fall making him face bruises and deteriorating health condition. The nurses have the ethical responsibility to maintain fairness in all clinical decision regarding care (Zolkefli, 2018). However, justice in care was found lacked regarding Jones as many laws and care principles are knowingly violated by the nurses and no whistleblowing was performed leading him to experience deteriorated health condition.

So What?

During the incident, I felt that all the professional values mentioned under 6 C’s of nursing were not followed by the nurses in delivering care for Jones. According to Fleet et al. (2019), the patients suffering from dementia are to be provided Rivastigmine, Donepezil and Galantamine to treat symptoms of dementia. This is because Rivastigmine and Donepezil promote increased presence of acetylcholine to help the never cells in the brain manage communication to ensure effective brain functioning (Kandiah et al. 2017). Moreover, Galantamine is seen to effect in reducing symptoms such as memory loss, confusion and hindered thinking by dementia patients (Bloniecki et al. 2017). In relation to this, I currently feel that the nurses to provide effective care to Jones could have used these medications as it would have impacted to lower his confused state to ensure better well-being. The NHS Constitution Values mentions that nurses are required to abide by the value of maintaining dignity and respect of the patient (NHS, 2018). However, I feel that this value is neglected by the nurses during caring for Jones. This is because Jones was allowed to be soiled and remain unkempt which led to lower his self-esteem and dignity. Moreover, his choice of care such as having solid foods and expressing need to see his wife was also neglected by nurses leading them to show disrespect towards his decision of care. At present, I feel that to maintain dignity and respect of Jones, the nurses need to ensure his hygienic condition and respect his care demands to provide support in controlling his dementia.

The NHS Values mentions that it is the duty of the nurses to work in collaboration for the patients and show commitment to care quality (NHS, 2018). During the incident regarding Jones, I feel that the nurses avoided working together as they avoided collaborating with his wife in caring for Jones that was his demand for care. Moreover, I feel that the nurses avoided showing effective commitment in caring for Jones which is evident as no effective precautions are taken to control his confusion and aggressive behaviour, meet his needs for diet and communication. However, currently, I feel that the nurse require to collaborate with psychologist to manage mental health of Jones. This is because psychologist helps patients with dementia to control and reduce mood and behaviour changes along with work with family to enhance the patient's living environment (Miller, 2018). Thus, involving psychologist to provide care to Jones in collaboration with the nurses would help them to control and reduce his confused mood and behaviour. Moreover, psychologist would educate nurses and Barbara regarding the way to emotionally care for Jones. This, in turn, would resolve Barbara’s confusion regarding the way to manage Jones's condition after discharge from the hospital.

The NHS Values mentions that it is duty of the nurses to improve well-being of the patients (NHS, 2018). However, I feel that the well-being of Jones is been compromised as the nurses avoided to ensure offering safe care to him as a result of which he was found to have deteriorated hygienic condition and even suffered fall. At present, I feel that nurses are to follow the guidelines of the Health and Social Care Act 2012 to ensure well-being to Jones. This is because Health and Social Care act 2012 mentions the duties to be performed to enhance care quality and outcomes of the patients along with reposition care provision to ensure the care is provided in patient-centred way that facilitates their choice of support (legislation.gov.uk, 2012). As criticised by Bickford et al (2019), lack of compassionate care for the dementia patients makes them show lack of compliance in care as well as deteriorated health outcomes. This is because the dementia patents consider them to be burden of care on the nurses and feel that the nurses are unable to understand their pain, in turn, making them avoid complying for care. Thus, I currently feel that compassionate care is essential to be provided to Jones during his stay at the hospital. This is because it would lead the nurses to make Jones comply with their care practice and avoid making unnecessary demands of avoiding to remain in bed or shouting, in turn, making the nurses promote his health and abide by professional values. This is evident as according to 6 C's of nursing and NHS Constitution Values, compassion is one of the professional value of the nurses (RCN, 2015; NHS, 2018).

The only positive impact emerged from the care intervention for Jones is that healthcare ethics of non-maleficence is abided which is evident as no intended abuse or harm from the nurses are done towards him during the care. The Mental Health Act 1983 mentions that mentally-ill individuals are to be empowered to take their own care, maximise independence of care, offer dignity and respect to the patient, maintain care efficiency and equity (legislation.gov.uk, 1983). In the given situation, all principles of the Mental Health Act 1983 were violated while caring for Jones creating legal issues for the nurse and deteriorated health condition of the patient. The NMC Code of Practice informs that care is to be provided in the best interest of the patient and the psychological along with physical and social needs of the patients are to be fulfilled (NMC 2018). However, these actions were violated as nurses did not provide care in the best interest of Jones which is evident as his demand of care by his wife along with need of having solid food were ignored to be fulfilled by the nurses creating a troublesome care environment for the individual. The other limitation was that Barbara was not included in caring for Jones which was his key demand due to which it may have led him to feel lack of value and respect from nurses. The Francis report mentions that each healthcare organisation is required to have whitsleblowing principles to ensure safety for the patient (health.org.uk, 2015). However, case of Jones, no whistleblowing was performed that led him to remain deprived of appropriate care with no appropriate actions being taken to resolve his hindered care at the hospital.

The effect of analyzing Jones’s care indicated that effective actions to improve professionalism and enhance care for the individual are identified. Thus, to alter the healthcare situation for Jones, the nurses involved in his care are to be trained regarding the way 6C's of nursing is to be abided in delivering care to him. The NMC Code of Practice mentions that patients are to be provided with information and responsibility in making care decision (NMC, 2015). Thus, to ensure autonomy to Jones in making care decision, the principle of NMC is to be followed by the nurses. The nurses are to arrange care plan for Jones to support beneficence which is to be fulfilled by following the NICE guidelines for management of dementia. The NICE mentions that acetyl-cholinesterase such as Rivastigmine, donepezil and galantamine are monotherapies to be used for managing dementia. The cognitive rehabilitation therapy, interpersonal therapy and cognitive simulation therapy are to be provided to promote cognitive, well-being and independence of dementia patients (NICE, 2020). Thus, these guidelines are to be followed to alter care for Jones as it would help him control over expression of symptoms regarding dementia and promote independence, in turn, acting to create beneficence for his health condition. In delivering therapies, a psychologist is to be involved for Jones.

The NMC Code of Practice mentions that nurses are to develop clarified communication with the patents by using the best available device along with work corporately with the colleagues in sharing ideas of care to deliver quality support (NMC, 2018). In case of Jones, to improve his currently deteriorated care, the nurses are required to develop alternative communication way other than written communication to interact with him. Moreover, the nurses are required to develop communication with colleagues and security staffs so that they can share their responsibility to provide safe and secured care to the patient. According to Bayen et al. (2017), for preventing unnecessary falls among the elderly the hospital beds are to be lowered to the floor and essential needs are to be kept by the side of the bed. Thus, the strategies are to be followed for Jones to prevent further fall during stay in the hospital. Moreover, continuous monitoring of Jones is to be maintained as he shows indication of frequently leave the bed. The fundaments of nursing care inform that hygienic and clean care environment for the patient is to be maintained (Gilbert et al. 2019). This is because hygienic environment prevents deterioration of health due to additional diseases as well as raise self-esteem of patients. Thus, nurses are to ensure personal and environmental hygiene for Jones to make him feel dignified and develop self-esteem.

The NMC Code of Practice mentions that specific needs and demands of care of the patients are to be identified and fulfilled by the nurses (NMC, 2018). In this respect, the food provided to Jones is to changes to solid and replacement of his dentures are to be made by the nurses so that he is able to appropriate chew and swallow the food. This is because he expresses to avoid taking liquid diet being currently provided to him due to his lost dentures. The NHS values along with the NMC Code of Practice mentions that compassionate care is to be provided to the patients for improving their well-being (NMC, 2018). Thus, this is to be followed in altering the care for Jones according to which the nurses would remain calm and show compassion towards his confused and aggressive behaviour to make him feel being understood. This is because it would make Jones feel the nurses perceive his health complication and are going to offer him appropriate care. The NHS values mention that commitment in care is referred to striving to ensure safety, confidentiality, professional integrity, accountability and good communication (NHS, 2018). In this regard, to alter the care for Jones, the nurses are to show accountability in protecting his dignity and respect by providing care according to his need. Moreover, Whistleblowing is also required to be introduced in the hospital so that inappropriate care towards Jones is reported and effective actions are taken to ensure best and safe care for him. The family-centred care is referred to the healthcare approach in which the healthcare workers form partnership with the family members of the patients to educate them regarding the way to assist and care for the patient (Dening and Hibberd, 2016). Thus, in case of Jones, since he is suffering from dementia which has led to his hindered cognitive thinking the family-centred care is to be implemented. This is because it would help to include Barabar in caring for Jones which would fulfil his wish as well as resolve the confusion of Barabara regarding the way to support Jones to improve her health and control mental capacity after discharge from the hospital.

Conclusion

The above discussion mentions that Jones is a 78-year-old dementia patient who is admitted to the hospital with complication of raised symptoms regarding the disease. The Driscoll’s reflective model is used for reflecting on the care of Jones because it is the simplest model that allows the strength and limitation of the situation to be identified for determining alteration of care required for the patients. The reflection led to highlight that the 6 C's of nursing care are not effectively followed by the nurses as well as autonomy and beneficence are violated but non-maleficence is ensured. The is evident as hindered care was provided to Jones by not abiding by his specific need such as care assistance from Barbara, having solid food, maintaining hygiene and others. The So what? section of the model led to indicate that lack of improved medication, involvement of psychologist, use of different mode of communication, respectful care and other actions are troublesome actions that led to deteriorated care for Jones. Moreover, it was mentioned that the Health and Social Care Act 2012 and the Mental Health Act 1983 are violated while caring for Jones. In this context, the NICE guidelines for dementia management and the NMC Code of Practice are to be followed by the nurses in caring for Jones to improve his health condition.

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