Ethical Compassion in Nursing Practice

Introduction

An integral part of the healthcare system is nursing which encompasses the promotion and prevention of health and illness for people of all ages in the communities. It promotes advocacy, safe care environment, enhanced healthcare management and others. In this essay, the case study of Keisha is to be explored to identify key needs in care to be fulfilled by nurses to deliver her enhanced nursing care. For those seeking specialised support, nursing dissertation help can be invaluable in addressing complex care scenarios. The ethical principles and policies to be followed in delivering care to Keisha are to be discussed. Moreover, the nursing leadership to be followed in delivering person-centred care to Keisha is to be explained. Thereafter, the way and importance of sensitive and compassionate communication for enhanced care of Keisha are to be discussed.

Case Study

The case study mentions that Keisha is a 20-year old woman with type-1 diabetes and Down syndrome. She is mainly cared by her mother Olumbumni and has a boyfriend currently who wish to take her out on dates, gifts pricy things and expensive chocolates. She has currently developed weight due to which she refuses to eat and due to the condition, she experiences hypoglycaemia that leads her mother to provide insulin injection after which she still refuses to eat her meal without bothering of facing further hypoglycaemia. She was recently admitted to the hospital as she fainted while out shopping with her mother and was found to be able to reply to most of the queries, but her mother seems to interfere in each aspect. Keisha was upset by her mother’s behaviour whereas her mother reports being worrying about her daughter getting pregnant and STD due to Keisha’s current advances with Kemal, her boyfriend.

Discussion

Care needs identified by using Biopsycho-social model

The Biopsycho-social model by Engel informs that for understanding the medical condition and needs of the patients, the psychological and social factors of health are to be considered along with biological factors of health (Frazier, 2020). The model is to be used for identifying key needs of Keisha as it helps in making holistic analyses of her health to determine her key needs and demands to be fulfilled through care. The psychological needs of patients are mental, intellectual and emotional demands to be fulfilled through enhanced care (Papadimitriou, 2017). The case study of Keisha informs that she suffers from Down syndrome due to which she has been dependent for care on her mother. Her mother is currently avoiding her to take independent decisions irrespective of her ability to do so which is leading her to remain unhappy. Thus, one of her psychological needs is to be happy by accessing support to make independent decisions regarding her care with least control from her mother.

The patients with Down syndrome are seen to face from general anxiety regarding their health (Rodríguez et al., 2018). In the case of Keisha, it is seen that she is anxious regarding recent weight gain which has led her to avoid eating proper meals that is negatively affecting her physical health such as increased presence of hypoglycaemia. Thus, another psychological need of Keisha is the presence of behaviour support to cope her from anxiety regarding her increased body weight and maintain normal body weight. The case study also informs that Keisha’s mother is continuously interfering in her life and relationship with Kemal which is making her feel uncomfortable and interference with her life. Therefore, the other psychological need of Keisha is the presence of emotional support to help Keisha communicate effectively with her mother without feeling interference in her life. The presence of Down syndrome leads individuals to develop cognitive impulsivity due to which they are unable to compare between consequences of current and future conditions regarding their behaviour (Dekker et al., 2018). Keisha is mentioned to have Down Syndrome due to which she is suffering cognitive impulsivity that is to be managed.

The biological condition of Keisha informs that she is suffering from Down syndrome and type-1 diabetes. Type-1 diabetes remains in control with intake of proper amount and nature of meal and intake of medication following by insulin injection (Lennerz et al., 2018). In case of Keisha, it is seen that she is avoiding taking proper meals and it has led her to develop hypoglycaemia continuously irrespective of her insulin intake. This is because intake of insulin without enough food leads the body to fail to produce increased glucose out of lack of carbohydrates that acts as the source for the production of the blood glucose in normalising blood sugar (Granado-Casas et al., 2019). In this condition, the key need of Keshia is to control type-1 diabetes by supporting and educating her on the way and importance of balanced diet and influence her to take proper meals. The other biological need of Keisha is management of enhanced body weight. This is because her increased body weight is seen to interfere with her ability to act normally in life and maintain healthy conditions. In this respect, Keisha’s need is presence of physical activity support to assist her in normalising her body weight.

The social needs of Keisha identified through the use of biopsychosocial model of health is presence of active lifestyle where she can independently involve in social gathering and meet with friends to have independent exposure in society. This is because the overprotective nature of Keisha’s mothers is interfering with her ability to interact freely and involve socially with people as determined from communicating with her mother. It is evident as her mother reported to control her way and what Keisha is to speak as she feels due to Down syndrome she is not capable to make her own decision effectively.

Ethical principle and policies in care

The ethical principles are required to be followed in nursing care so that quality support can be provided to the patients for their enhanced health condition. In nursing, the key ethical principles are justice, beneficence, autonomy and non-maleficence (Butts and Rich, 2019). Justice is referred to fairness in the distribution of care by the nurses to all patients and groups (Podgorica et al., 2020). According to this ethical principle, the nurses liable to provide care to Keisha are to ensure fair support is provided to her in all condition like similar patients and no discrimination is made in delivering her care due to stigmatisation of the presence of Down Syndrome. The NMC Code of Conduct mentions that fair care by determining the needs and demands of the patients is to be provided by the nurses (NMC, 2018). Therefore, the nurses providing care for Keisha are liable to maintain fairness in care under the NMC Code.

The ethical principle of beneficence mentions that nurses are to act with kindness, mercy and good behaviour to provide best care beneficial for the health of the patients (Tural et al., 2020). The NMC Code of Conduct also mentions that nurses are to deliver care in the best interest of the patient by the nurses by upholding their professional values and duties (NMC, 2018). Thus, in respect to the NMC Code and ethical principle of beneficence, it is the legal and ethical duty of the nurses to delivery the best supporting care to Keisha. The ethical principle of autonomy mentions that nurses are to provide right to the patients in making their own decision regarding care without influencing them or forcing them to incline them to any other care (Hedman et al., 2019). In order to abide by the ethical principle, the nurses caring for Keisha is to ensure they consider and follow the decision regarding care made by Keisha irrespective of the influence and preference of her mother. This is because the interference of her mother is seen to create barrier towards the expression of her will regarding care autonomously and she is found to be upset regarding the condition.

The Mental Health Act 1983 mentions that any mentally ill individuals are to be provided opportunity in making their own decision regarding care unless they are capable to do so for which they can be provided assistance to make decision (legislation.gov.uk, 1983). In this relation to the Act, Keisha’s mother is also to be avoided to interfere in making decision regarding Keisha’s care. This is because Keisha expresses enhanced ability and understanding irrespective of the presence of Down’s syndrome to reply to all queries made regarding her health and care by the nurses showing enhanced decision-making capability for her own care. The Data Protection Act 1998 informed that no personal data and information of the patients are to be shared without accessing consent from them (legislation.gov.uk, 1998). In respect to the Act, nurses taking care of Keisha is to ensure that no personal information are to be shared publicly without her consent and her privacy is to be maintained in all context.

Nursing leadership for Person-centred care

The leadership processes to be followed in nursing care by nurses for delivering person-centred care to the patients are operationalisation of objectives regarding person-centred being, promotion of supportive atmosphere for person-centred care, maximisation of team potential for person-centred care and optimising support structures for person-centred care (Backman et al., 2020). The operationalisation of objectives of person-centred care (PCC) mentions that the leaders in nursing are to support the development of specific person-centred care objectives for each patient by reviewing the needs and demands of the service users by the nurses (Cardiff et al., 2018). This indicates that in leading person-centred care for Keisha, the initial approach would be to develop PCC objectives for the patient that is specific to his health condition. The PCC objectives for Keisha are the promotion of healthcare for managing psychological needs like cognitive impulsivity and emotional turmoil due to interference in care, improving physical health conditions such as weight gain and type-1 diabetes with prevention from STD and the improvement of her social condition to freely interact with others.

In order to establish PCC, promotion of supportive atmosphere in care is to be made which indicates that effective supportive relationships between nurses and patients are to be maintained. This is because without effective support from nurses the patients would be unable include personally in taking decision regarding care as well as lack of support from patients would lead the nurses unable to determine the patient’s personal needs and demands to be considered in making the PCC plan (Bhattacharyya et al., 2019). Thus, the nurses working with Keisha are to support each other in establishing the PCC plan. It is to be achieved by framing compassionate and sensitive communication by the nurses with the patient (Keisha). The initial support to be arranged for Keisha is making her participate in PCC is avoiding his mother to interfere and report her needs. The nurses while communicating with Keisha to understand her needs and provide her opportunity to personally inform which she has the capability to execute are required to isolate Keisha from her mother.

The other leadership approach for PCC is maximisation of team potential for delivering PCC according to which multi-disciplinary team members are to be included. This indicates that varied team members in PCC is to be present so that through the use of different level of expertise, the individual needs and demands of the patients are effectively resolved (Jenkins et al., 2018). Thus, a multi-disciplinary care team is to be recruited for PCC of Keisha in meeting her specific needs. The NICE guidelines mention that therapeutic intervention along with active cognitive assistance that are supervised by the psychiatrist is to be provided to people with Down syndrome for enhancing their cognitive ability (NICE, 2016). In this respect, the PCC team for Keisha is required to include a psychiatrist who would involve her in cognitive therapy to improve his level of expressed cognitive impulsivity. The psychiatrists are also required to communicate with Keisha’s mother to inform her way she provides space to her daughter and its benefit for the person to resolve the continuous interference faced by Keisha in her life that upsets her mood.

The NICE guidelines mention that effective exercise and diet control is required to be followed by type-1 diabetes patients to control their glycaemic condition (NICE, 2015). The dieticians inform the way balanced diets are to be maintained by individuals to control their healthy weight (Dimitriades and Pillay, 2021). However, the physical trainer informs the way exercise is to be specifically made by each individual in respect to their age and health condition to maintain good health (Bogale et al., 2021). In this respect, the PCC multi-disciplinary team for Keisha is required to include dietician who would inform her regarding the way to maintain diet and which foods are currently leading her to gain body weight that are to be avoided to normalise her weight. The dietician for Kesha is also required to involve her boyfriend Kemal who is close to her along with her mother to understand the foods they are to provide her to support her maintain normal body weight and avoid exacerbation of the type-1 diabetic condition. Moreover, a psychical trainer for Keisha is also to be included who would guide her and inform the importance of exercise in strategically losing her body weight and manage type-1 diabetes from exacerbation that has been faced currently.

The NICE guidelines mention that patients with intellectual disability like Down syndrome are to be involved in occupational therapy. This is because it helps in promoting self-care ability among the individuals and avoid them to be burden or dependent for care on others (NICE, 2019). Therefore, Keisha is to be involved in this therapy and occupational therapist are to be involved in the PCC team for delivering the care to Keisha. The optimising support structures indicates that to delivery person-centred care, the nurses are to rearrange the structures of care in such a way so that they support person needs of each patient in specific way (Backman et al., 2020). This indicates that leading PCC for Keisha requires the nurses to make required changes in their support structure if required to support her enhanced health and well-being.

Role of sensitive and compassionate communication

The role of sensitive and compassionate communication in nursing is that it helps to create enhanced social connection with the patients required for identifying their key needs and demands along with frame person-centred care approach. This is because sensitive and compassionate interaction leads the nurses to show seriousness towards the information of care needs shared by the patients. Moreover, it leads the nurses show empathy towards the patient which make them understand the nurses feel their pain regarding health and are trying to derive better care for them (Sisk et al., 2018). This leads the patients to feel valued and trusted towards the patients, in turn making form effective social connection to interact freely with the nurses regarding their health needs and demands (Singh et al., 2018). As argued by Noble et al. (2018), uncompassionate communication makes the nurses show they do not understand the condition through which the patients are going and have an indifferent attitude towards their pain and complication regarding health. It leads the patients like Keisha to feel lack of value which makes them avoid making enhanced social connection with the nurses that are key to initiate effective person-centred care.

The sensitive and compassionate communication by the nurses plays the role of making patients feel relived of any stress regarding their health or accessing healthcare. This is because the nature of communication leads the nurses to make patients feel they are welcomed to share any information without fear or interference from others to be appropriately listened to resolve it (Gilbert, 2020). Thus, sensitive and compassionate communication is to be followed for Keisha as it would make her feel confident and lack of fear that her mother or any other individual would interfere leading her to share personal information with confidence to access assistance and promotion of enhanced well-being. The role of sensitive and compassionate communication in nursing that it leads to create cooperative behaviour between nurses and patients, in turn, leading to create quality health outcome (Fenstermacher and Hupcey, 2019). This is because such communication upholds dignity and respect of the patients which makes them feel valued and show cooperation in care instead of non-compliance due to lack of value.

The role of sensitive and compassionate communication in nursing is that it promotes delivering enhanced person-centred care. This is because the nature of interaction leads the nurses to effectively share all information regarding their care along with allow patients to inform their choice regarding the care to be discussed together in reaching enhanced person-centred care plan (Huffman, 2017). The nature of communication also leads the nurses to identify emotional concerns and risk according to the patients present for them. This is because compassionate and sensitive interaction leads the patients to feel effectively listened and taken as important individuals by the nurses (Bumb et al., 2017). Therefore, sensitive and compassionate communication is to be maintained for Keisha so that she can feel free to report of any further concerns regarding her mother that are to be resolved or managed to improve her health and well-being. The role of sensitive and compassionate communication is that it creates enhanced opportunity to two-way flow of information and understanding between patients and nurses (Sinclair et al., 2018). This is vital to be followed for Keisha’s care so that the nurses can make her understand way she is vulnerable to STD and way to control it along with the importance of following the specific control measures for her health.

Conclusion

The above discussion mentions that Keisha is suffering from an exacerbation of type-1 diabetes condition due to improper meal intake and is showing emotional turmoil that are to be managed. For this purpose, person-centred care for the patient is to be arranged for the patients as it helps in specifically meeting her required personal needs and demands of care. The ethical principles of beneficence, autonomy, non-maleficence and justice are to be followed in caring for Keisha by the nurses. The legislation such as Data Protection Act 1998 and Mental Health Act 2015 are to be followed in delivering her care. The leadership approaches to be followed in delivering person-centred care to Keisha are setting person-centred care objectives, promotion person-centred care, develop team and optimising care structure for person-centred care. The role of sensitive and compassionate communication for Keisha is that it would create better health outcome for her along with provide her greater care satisfaction, ability to report needs and concerns for care, face happiness in care and others.

Recommendations

The recommendation developed from the study is that in all way Keisha’s mother inappropriate interference while communication by the nurses with her in the hospital is to be avoided. Keisha is to be taken to separate room during communication and nurses are to separately interact with her mother to know her concerns and needs of care for her daughter to be fulfilled by the nurses. The nurses are recommended to perform cognitive ability checking of Keisha to understand to what extent she is capable to participate in care without the need of her mother who avoids considering her freedom in speaking at each time irrespective of her ability to speak with effective understanding with the nurses.

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