Reflection On Mrs Hs Case Using Bortons Framework

Introduction

The purpose of the assignment is to reflect and highlight the problems regarding care I found after reading the case study which is published by the Parliamentary and Health Service Ombudsman (2011). The plan is to follow the stages mentioned in the Borton’s Framework of Reflection that is chosen as the reflective model to be used for this assignment as it is one of the straightforward reflective frameworks that can be easily implemented. As a Nursing student, reflective practice is important for me to understand the way my actions are to be enhanced. The NMC Code informs that nurses are to execute reflective practice so that they are able to understand the improvements to be made for delivering best car services of highest professional standards to the service users (NMC, 2015). The assignment is going to be focused on Mrs H’s case and the name as reported is to be used to maintain confidentiality.

The case study informs that Mrs H was 88-years old who was partially sighted and deaf but was living a dignified and proud life independently without anyone’s help by managing her everyday needs on her own most of the times. She was admitted to the hospital only after she suffered a fall at her home and remained at the place for approximately four months before her transfer to a care home. During her stay at the hospital, the case mentions that the nurses irresponsibly cared for her which is evident as she suffered many falls one of which led her to break her collar bone (www.ombudsman.org.uk, 2011).

She was provided to wear baggy clothes which were not her even though she had brought her own clothes to at the hospital during the admission. It was also reported that many nursing records regarding her were vague and no document of receipt of her clothes was found due to which she was made to wear wrong clothes of others. She suffered from mild malnutrition and lost 11lbs of weight. Further, the communication between her and nurses in the hospital was poor and her personal hygiene was not maintained. This is evident as when she was received at the care home she was wearing untidy clothes and soaked in urine as well as brought clothes with her that were dirty (www.ombudsman.org.uk, 2011).

There was no patient handover information available and Mrs H’s only family member living in New Zealand was not reported of any such occurrences. Thus, the case informs that there were many areas of practice which was not effectively managed and neglected the patient's condition as well as the legal framework suggested by the NMC. Therefore, I am researching this case to identify where better practices required to be implemented and which policies and procedures are to be abided that could have improved Mrs H’s condition and stay at the hospital.

According to NICE guidelines, hospital and nurses are entrusted to execute multi-factorial risk assessment of elderly patient who are admitted due to previous falls for identifying their individual fall risks during their stay at the hospital so that they can be treated and managed accordingly to ensure safety (www.nice.org.uk, 2013). However, Mrs H’s case study does not provide any evidence whether or not any risk assessment has been made which indicates the hospital has not followed the NICE guidelines provided to prevent falls of elderly patients.

The NICE informs that people above 65yeras of age are more prone to experience falls with 30% fall experienced by people over 65 years and 50% fall experienced by elderly over 80 years once a year. These falls among the elderly causes the NHS bear the cost of £2.3 billion per year cost (www.nice.org.uk, 2013a). The facts were ignored by the nurses who were caring for Mrs H in the hospital which is evident as if the nurses would have cared they would have provided proper care and executed risk assessment of the patient to avoid her further fall. Thus, it indicates that safeguarding issues for Mrs H aroused as the nurses did not take proper care to avoid her fall making her be in a vulnerable position in the hospital.

The case study reported that Mrs H was dignified person and managed her everyday chores independently before the fall and admission to the hospital (www.ombudsman.org.uk, 2011). A fall among elderly patients negatively affects their self-controlling behaviour and makes them lose dignity along with self-respect. This is because falls in public lead the elderly individuals to get embarrassed and perceive they are going to be burden of care on others (Cox et al. 2018; Friebel et al. 2017). Thus, Mrs H previous falls may have lead her to lose self-confidence and dignity that could have contributed to making her confused leading her to face further falls.

In the case study, it was seen that Mrs H was already facing mild malnutrition and after the admission to the hospital has lost 11lbs of weight (www.ombudsman.org.uk, 2011). The NICE guidelines indicate that nurses are to monitor the nutrition needs of the patients and mainly those are at risk of malnutrition (www.nice.org.uk, 2013). In case of Mrs H, the guideline was may be violated as no monitoring of her nutrition status was reported to be made even after report of her slight malnutrition by any nurses during her stay at the hospital. However, there was no mention whether lack of proper food and nutrition was the cause behind her reduction in weight or her medical condition took toll on her body that leads her to lose weight. Thus, the violation of the nutrition cannot be regarded as only cause of her weight reduction.

The UK government under the International Covenant on Economic, Social and Cultural Rights (ICESCR) recognises right to food and water for all individuals (www.barrowcadbury.org.uk, 2014). However, in Mrs H's case, the right may have been violated due to which she was not provided adequate nutritious food that led her to face reduction in body weight. The food provided to Mrs H was may be of poor quality and not culturally competent that avoided her to eat properly and lose weight. Further, Mrs H may be unable to personally feed her and there was no assistance provided to her or she was ashamed to get help that leads her to avoid intake of proper nutrition which eventually contributed to her weight loss. In each hospital in the UK, food charts are available that are to be followed by the nurses to provide food and water to the patients (www.bhamcommunity.nhs.uk, 2011). In the mentioned case, the charts may not have been available that made the nurses unable to provide proper nutritious food to Mrs H that contributed to her reduced weight.

In the case study, it was reported that Mrs H was partially sighted and deaf along with could only communicate in British Sign Language and read words written in larger fonts (www.ombudsman.org.uk, 2011). However, there was no mention of any special initiative or assistive technology being used by any nurses to communicate with her to understand her needs and demands. The communication between nurses and service users is essential to get informed about their needs and demands so that the care services can be designed accordingly to provide quality and satisfactory care to the patients (Cranwell et al. 2016; Bach and Grant, 2015). Thus, the lack of establishment of communication between Mrs H and nurses may have contributed to her improper treatment at the hospital.

During stay at the hospital, it was reported that Mrs H was not provided tidy clothes of her own and provided to wear clothes that did not fit her at all (www.ombudsman.org.uk, 2011). It may have contributed to lower her self-image that in turn negatively affected mental state of Mrs H as untidy clothing is related to lower self-image and dignity of person. Moreover, she was previously reported to be concerned about her appearances. Thus, her recent improper appearances may have affected the pride that made her mental health to get influenced in a negative way. Mrs H was reported to be received at the care home soaked in urine and untidy clothes which may have also affected her dignity and self-esteem. This is because improper hygiene is related to lower dignity (Adib-Hajbaghery and Aghajani, 2015; Beauchamp and Childress, 2013). The NMC Code indicates that the dignity of the individuals is to be ensured while care (NMC, 2015). However, the case study informs that nurses did not take any initiative to uphold the dignity of Mrs H that may have further contributed to her deteriorated health. In relation to this, I think that holistic care and therapeutic intervention along with proper communication, timely risk management and care services could have avoided such negative health consequences for Mrs H.

The analysis of the case study made me realise that nurses are to learn from their mistake and upgrade their skills to prevent such issues. This is evident as similar steps are seen to be taken by the hospital at the conclusion of the care to prevent such negative consequences in future. The FallSafe Project informed that to reduce harm from falls facilities and training is to be provided to the nurses to help them create safe environment for the patient. Moreover, the project informs that high –risk patients are to be thoroughly assessed and all patients with risk of falls are being asked about any falls before admission, avoid them sedative medication, ensure they wear slip-proof footwear and calling bell is to be provided near to their bed to help them alert in need without moving (www.health.org.uk, 2011). This is required as training nurses would make them knowledgeable to understand way falls are to be prevented and prior assessment of patient would help nurses to identify which patients are at risk of fall. The slip-proof footwear is going to reduce falls of patients while walking. Thus, the interventions mentioned in the project are to be followed by the nurses for elderly patients to prevent falls.

The case study also made me understand that communication is an important part of care planning. This is because through communication with the patients I could understand their specific needs and demands related to their health and culture according to which I would frame the care plan to ensure better health of the individuals. Moreover, I would follow the Roper-Logan-Tierney model for nursing to provide holistic care to the individuals like Mrs H and others. This is because the model helps nurses to focus on all the key twelve daily activities required to be managed for an individual to offer them holistic care (Williams, 2017). Holistic care is important to care for the person as a whole by the nurses and not just the diagnosis or the patient only. The NMC Code informs that nurses are to work collectively and collaboratively to provide care to patients (NMC, 2015). This is important to be abided by as collaborative working leads nurses to share ideas and information between one another required for nurses to improve care services for the patients under their care.

The vague nursing records of Mrs H is required to be resolved by training the nurses to understand the way they are to arrange proper health records for the patients. The information about the family members to be contacted for each patient is to be stored with the password in computer that is to be shared with the nurses. This is to help nurses find email, phone address and others to communicate happenings with the patients directly to their family members (Dougherty and Lister, 2015). The nurses are to communicate in an empathetic and compassionate way with patients like Mrs H to make them understand the patient’s needs. The nurses are to ensure proper hygiene of the patients and deliver care in such a way so that the dignities of the service users are uplifted (Dougherty and Lister, 2015). The nurses to provide best practices are to follow 6 C’s that are care, compassion, courage, commitment, communication and competence as suggested by the NHS and Department of Health (www.england.nhs.uk, 2019). Moreover, the food and services are to be provided to patients in such a way so that their cultural sentiments are not hurt as it would make the patients more effectively accept care from nurses with less conflict.

Conclusion

The above discussion indicates that student nurses to provide quality care to service users required to abide by with health policy guidelines and interventions mentioned in health projects. The Roper-Logan-Tierney model for nursing is to be abided by student nurses so that they understand patient’s daily needs and demands to be fulfilled for offering them holistic and person-centred care. The analysis also made me as a student nurse understand that dignity of patient is to be upheld as per the way I personally wished to be treated and proper hygiene is to be maintained for the patients. The feedback from the patients is to be thoroughly examined and accordingly changes in care are to be made to ensure proper health support for the service users.

Reference list:

• Adib-Hajbaghery, M. and Aghajani, M., 2015. Patients dignity in nursing. Nurs Midwifery Stud, 4(1), p.e22809.
• Bach, S. and Grant, A., 2015. Communication and interpersonal skills in nursing. Learning Matters.
• Beauchamp, T.L. and Childress, J.F. (2013) Principles of Biomedical Ethics. 7th edn, New York: Oxford University.
• Cox, S., Roggenkamp, R., Bernard, S. and Smith, K., 2018. The epidemiology of elderly falls attended by emergency medical services in Victoria, Australia. Injury, 49(9), pp.1712-1719.
• Cranwell, K., Polacsek, M. and McCann, T.V., 2016. Improving mental health service users’ with medical co-morbidity transition between tertiary medical hospital and primary care services: a qualitative study. BMC health services research, 16(1), p.302.
• Dougherty, L. and Lister, S. eds., 2015. The Royal Marsden manual of clinical nursing procedures. John Wiley & Sons.
• Friebel, R., Dharmarajan, K., Krumholz, H.M. and Steventon, A., 2017. Reductions in readmission rates are associated with modest improvements in patient-reported health gains following hip and knee replacement in England. Medical care, 55(9), p.834.
• Williams, B.C., 2017. The Roper-logan-tierney model of nursing. Nursing2018 Critical Care, 12(1), pp.17-20.
• www.barrowcadbury.org.uk 2014, Going Hungry? The Human Right to Food in the UK, Available at: https://www.barrowcadbury.org.uk/wp-content/uploads/2014/04/Going-Hungry-Human-Right-to-Food-REPORT-FINAL-1.pdf [Accessed on: 28 May 2019]
• www.bhamcommunity.nhs.uk 2011, NUTRITIONAL GUIDELINES: Specific to Community Hospitals, Available at: http://webcache.googleusercontent.com/search?q=cache:MRG4Su030BUJ:www.bhamcommunity.nhs.uk/EasySiteWeb/GatewayLink.aspx%3FalId%3D11913+&cd=10&hl=en&ct=clnk&gl=in [Accessed on: 27 May 2019]
• www.england.nhs.uk 2019, The 6Cs, Available at: https://www.england.nhs.uk/leadingchange/about/the-6cs/ [Accessed on: 28 May 2019]
• www.health.org.uk 2011, The FallSafe project, Available at: https://www.health.org.uk/sites/default/files/CtGtCC_FallSafe_Report.pdf [Accessed on: 25 May 2019]
• www.nice.org.uk 2013, Falls in older people: assessing risk and prevention, Available at: https://www.nice.org.uk/guidance/cg161/chapter/recommendations [Accessed on: 28 May 2019]
• www.nice.org.uk 2013a, Falls: Assessment and prevention of falls in older people, Available at: https://www.nice.org.uk/guidance/cg161/evidence/falls-full-guidance-190033741 [Accessed on: 27 May 2019]
• www.nmc.org.uk 2015, The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates, Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on: 29 May 2019]
• www.ombudsman.org.uk 2011, Care and compassion?, Available at: https://www.ombudsman.org.uk/sites/default/files/2016-10/Care%20and%20Compassion.pdf [Accessed on: 29 May 2019]