Health, Promoting Good Practice - Essay Example

Health, Promoting Good Practice [The [The of the Health, Promoting Good Practice Introduction This essay will critically assess a case study involving screening of health professionals. Firstly it will define health promotion and its attributes, then by using relevant course materials it will evaluate a number of issues in relation to the case study. It will consider what is characterised by the term 'good practice', look at the things that may strengthen the initiative and discuss the ethical dilemmas that may be associated with the scheme. Current Information Mrs Marie Brown is 78 years old. She was admitted to hospital through Accident and Emergency following a fall at home. She is currently on an acute mixed ward for older people; this is her 3rd day of hospital stay. She was found on the floor in her living room, following a fall, by the person who delivers her Meals on Wheels at midday, who has a key to the house. Social Situation Mrs Marie Brown lives alone in her own 4 bedroom detached house in the suburbs of the city. Her husband died 4 months ago from cancer. She had been married 58 years. She has one daughter who lives nearby called Claire. She works full time, but helps with shopping and housework(1). Other Information Mrs Brown keeps a large amount of cash in the house to pay bills rather than use the bank. Marie's nationality is French and English is not her first language. Marie has exhibited signs of short term memory problems since the death of her husband and has recently started to revert to her mother tongue of French. Medical Information Mrs Marie Brown has osteoporosis and chronic obstructive airways disease. She uses a nebuliser 3 times a day to assist her breathing. She becomes short of breath on exertion. (Becomes short of breath when she moves around). Functional Information Prior to admission Mrs Marie Brown could shuffle a short distance of 5-6 steps, whilst using her zimmer frame. She sleeps in one of her downstairs rooms, with a commode next to the bed and her armchair is within easy reach. At present she is unable to stand by herself and requires assistance of one person for toileting and personal care. Services Received at home A home carer attends twice a day, to assist with a.m. getting up, washed and dressed and making breakfast. They also attend in the evening to assist Mrs Brown to get undressed and into bed. The home carers hold keys to the house. Professionals Involved prior to admission A social worker (SW) for older people, from social services (SS) has assessed Mrs Brown following the death of her husband. The SW has arranged for the care package (Home Care and Meals on Wheels) to be in place. An Occupational Therapist, (Also from SS) has assessed Mrs Brown and has recommended and arranged for a commode, zimmer frame and bed and chair to be raised. The patient chosen for the purpose of this essay will be referred to as Mrs. Marie Brown. Mrs. Marie Brown is 78 year old women who suffer with rheumatoid arthritis. This also resulted in Brown having bilateral hip replacements. Brown is on steroid treatment, which leads to thinning of the skin and susceptibility to trauma (Mallet and Dougherty 2001). Brown lives with her husband and two grown up sons. Brown was refereed to the district nurse on her discharge from hospital following her second hip replacement. The initial referral was to check the surgical wound. However on arrival it was pointed out by Brown that she had a skin tear on her left shin that wasn't healing. The district nurse performed an assessment and concluded the wound was a venous leg ulcer as it had been present for 6 weeks. The district nurses used Sorbisan and Telfa to dress the wound. Twice weekly visits were carried out to Joe for a further 4 weeks, and it became obvious that the ulcer was not improving. The district nurse had to make a decision on what care to provide. The decision was to try another dressing Aticoat which is impregnated with silver, and not to refer the patient to the leg ulcer clinic at the local hospital. The district nurse involved with Brown's care was a G grade nurse and in charge of a community practice that had 3 other nurses working in it. The author decided to focus on this particular decision, as she was influenced by the amount of evidence based research available on the issue, and how the district nurse chose to ignore the evidence, and made a decision on the basis of personal knowledge. The author visited a leg ulcer clinic while on her community placement, and asked the expert nurses running the clinical at what stage they would like to see patients referred to them. She was told if a wound wasn't healing after 4 weeks the patient should be referred, this information was passed on to the district nurse and ignored. Health Promotion Activities No doubt, the World Health Organisation (WHO, 1986) describe health promotion as "...the process of facilitate people to add to control over, and to get better, their health. To reach a state of total physical, mental and social wellbeing, an individual or group have to be able to recognize and to realise aspirations, to satisfy needs, and to change or cope with the environment. Health is, so, seen as a resource for each day life, not the aim of living. Health is a positive idea emphasizing social and personal resources, as well as physical abilities. So, health promotion is not just the liability of the health sector, but goes beyond healthy lifestyles to psychosocial wellbeing" Jones and Naido (2000) portray five approaches to health promotion; Medical, Behaviour change, Educational, Client- centred and Societal change. The Portsmouth Health initiative described in the case study is based on the medical approach as its aim is to encourage people to seek earlier detection of illness and disease. The Portsmouth initiative can be seen as an example of good practice as identified in this description, since it aimed to improve the health of the staff. The Ottawa Charter (1998) terms this kind of initiative as 'empowerment' as it raises its clients awareness of the issues involved; it also allows the clients to read useful material about the tests(2). Nursing Role This assignment is concerned with developing skills in the ability to relate theoretical knowledge and evidence, obtained from nursing literature, to a patient for whom caring for. This exacting study aims to assess the care given to a patient diagnosed with leg ulceration. It will focal point on the wound management and bandaging system used, though one significant aspect of the successful care regime is the nurse patient relationship. This will be assessed to set up if the communication among the patient and nursing team bore any pressure in the care given. Nurses must be trained in the correct use of Doppler ultrasound. The patient must lie supine for twenty minutes before the test so the systolic blood pressure is not artificially elevated due to anxiety or exercise. In addition to relieve anxiety and gain consent, the nurse will explain the procedure. Other factors that affect the readings are room temperature and positioning of probe. All of the above should be documented by the attendance nurse and failure to do this can lead to care regimes being altered unnecessarily(3). Professional Staff Professional staff were given leaflets about the screening test being promoted and given an explanation of what the initiative involved. There is also the statement of further screening being available after the initial tests and as Juttmann et al (2001) explains, people who have regular screening tests are more likely to have something diagnosed early in life, and therefore have a better chance of being successfully treated. Another reason why health promotion and screening should be continuous is because diseases such as aids, BSE or heart disease are not reported frequently in the media and so they tend to be forgotten about. Health Promotion Practice Good practice was also demonstrated in the case study by the evaluation of the initiative. However, there are two types of evaluation the first being 'outcome evaluation' which is to help to rationalize the effort and resources that went into the project and it shows that it was worthwhile and effective. The second type is 'process evaluation' which provides the support that a company needs to keep their project going, it also highlights any errors made which can help a company to make improvements for the next time. In considering how the initiative could have been strengthened the case study itself includes one example. It highlights how the initiative will introduce mole screening for its clients, as it describes that this is something that the staff would like to see. However, the case study does not mention whether the screening was done in the work place, only that there were three road shows set up. Having screening tests available at work would be more beneficial to the staff as they would not have to travel, thus giving them more of an incentive to have the tests done. A company called Medifit offer health screening at work, they believe that this can benefit the workplace, as their records show that their initiative has helped to reduce levels of sickness absence, which is what the Portsmouth initiative was aiming to do, and WHO (1989) agree that "Carrying out health promotion in settings where people live, work, learn and play is a creative and effective way of improving health and quality of life."(4) A further way to strengthen the initiative could be to offer more support to the individuals taking part in the tests, as the case study illustrated that the people with positive results were given a letter and were told to see their own doctor. For example having a counsellor at the road-shows would have beneficial, as someone to talk to if the tests carried out showed positive results, can lessen the chances of uncertainty and anxiety. In addition, uncertainty can be reduced or prevented in a number of ways and as Wenchell (1995) suggested the more you know about a situation, the better a person can prepare themselves for it. Communicating with a doctor or consultant is a good way to gather information and DoH (2003) suggests that "Effective communication can reduce misunderstandings, conflicts and stress".(5) Nevertheless, for effective health promotion a company needs the financial and information resources. The World Health Organisation (WHO) explains that to strengthen health promotion initiatives we need to develop "...new and innovative ways for securing sustainable funding and accurate and updated health promotion profiles..."(2) One way to do this would be to educate people about health promotion, why it is important and by expanding the on the evidence for health promotion. Scriven (2001) touches on this subject and discusses teacher training. It is possible that if teachers were trained in health promotion then the need for governmental health promotion would be reduced, as children would have the knowledge earlier to live healthier lifestyles. The case study indicates that there may be ethical dilemmas with in the project. One such dilemma that was highlighted was the planning of the initiative as it there is no indication of planning involved. Jones et al (2000) depicts that any health promotion intervention must be planned, she suggests "Planning should be done with rather than for people" A technique to achieve this would be to carry out a questionnaire before hand rather than just introducing the initiative, as this would help health professionals to distinguish whether staff would be interested in participating in the project. Then by using the feed back the organisers could plan what assessments would be useful to their targeted audience. It would also show that the indented users of the promotion had some input into organising the project. By doing a questionnaire, it would diminish the negative feelings any staff may feel in relation to their employers knowing about their health issues. Although the Portsmouth initiative touches on the subject of confidentiality, the plan is for the project to minimise the levels of staff sickness and so the employers would need feed back from the screening and many of the employees may find this off putting. This points us in the direction of patients' rights and their need for autonomy. Patients' rights vary in dissimilar areas of the country and WHO (1998) suggest that there are four models which health professionals use: the paternalistic model, the educational model, the interpretive model, and the deliberative model. Every model proposes dissimilar responsibilities of the health professional on the way to the patient. For instance, the paternalistic model gives the patient the authority to make decisions regarding their health. This exacting model has a burly comparison by that of Jones et al (2000) humanist paradigm. The World Health Organisation (1998) explains the informative model as being "...the patient as a consumer who is in the best position to judge what is in her own interest, and thus views the doctor as chiefly a provider of information. The interpretive model, according to the American College of Obstetricians and Gynaecologists (2004), is when the expert helps the patient to elucidate their values into the decision making procedure while acting as an information supplier in respect to any medical process. While the deliberative model is where the professional engages the patient in a conversation on what course of action would be best. This model shadows Jones et al (2000) customary example of health promotion as the customary view is expert led(4). All people have rights to determine their own lives and not to be forced into anything which they do not want to do. For example if a person attending the screening has positive results on a few of the tests, they should not be forced to take further action. Jones and Crib (2001) introduce the question "By what right am I intervening and how do I justify the action I'm taking" By asking this question before intervening and persuading clients to take further action on their results, health professionals can moderately reduce the possibility of clients feeling as though they have been pushed into something they do not want. Seedhouse (1998) presents an ethical grid, and the case study seems to comply with this, as it suggests issues which should be used in the promotion of health. It advises that the health promotion should benefit its audience and although the most beneficial out come for the Portsmouth initiatives audience is not clearly shown in the case study, it does propose the benefits which the organisation hopes to gain. FEELINGS Consequently, the results for me were that I was tormented by my conscience, because deep down inside I knew that there was a potential problem which I was not addressing, and that there was a need to take advice from someone in authority to myself. I felt fearful of the repercussions of reporting the incident, so I tried to use a utilitarian approach to convince myself that by ignoring the incident and making the majority of people happy, that this problem would go away. EVALUATION - BAD POINTS The more I tried to evaluate this incident, the worst it became in my mind. There did not appear to be much good in a professional to client relationship like the one which I had witnessed. The care given by the professional should have been based on therapeutics. GOOD POINTS At first, I could not see any good points in this situation itself, however, looking back I can see that it did have its positive side, in as much as allowing me to examine myself and to search for my short fallings in relation to the incident. I feel that if I was not a 1st year student, I would have had more knowledge or communication skills on how to deal with an incident of this description, I also think that because the support worker was not a nurse, it made it more difficult for me to make a decision on what the correct procedure should have been. ACTION PLAN In order to prevent another situation of this kind happening to me again, I feel that I must act on my own values and beliefs, being careful not to impose them on anyone else. I will do the 'right' thing at any given moment in any given situation, regardless of the consequences. I will not ignore the situation next time, hoping that it will just disappear, because I know now that I could be held accountable if any serious issue came to light from something which I chose not to report. I have also learned that I need to further my assertiveness and communication skills so that I do not feel intimidated or belittled when addressing these issues to members of staff in senior positions to myself. I have also learned that positive experiences can be gained through negative incidents, as this one made me realize that I need to further develop my skills in order to offer the appropriate care which each client is worthy of receiving. Conclusion There is concluding evidence that the Portsmouth initiative provided good practice in some areas and that it conformed to the ethics in principle. The essay shows ways which the initiative could have been strengthened and discussed in depth the importance of support needed in order to protect their Mrs. Brown's mental wellbeing. Patient's rights', are an important issue, and were compared with four models of practice. There are many aspects of nursing that cannot be subjected to measurement, and intuition is one of them, and so is caring. To ignore intuition as a nursing skill would be to deny the patient of truly holistic care. However I would say that the nurse involved with Brown's care was not an expert in the care of leg ulcers, and was baseing his care on limited research. The effect this had on the patient was a poor standard of care. Endnotes 1. American College of Obstetricians and Gynaecologists (2004) Surgery and patient choice, Available from: http://www.acog.org/from_home /publications/ethics/ethics 021.pdf [accessed 10 March 2005] 2. Department of Heath (2003) Carers Corner, Available from: http://www.info.gov.hk/elderly/english/healthinfo/elderly/comm_skilful-e.htm [accessed 1st March 2004] 3. Jones, L. & Crib, A. (2000) 'Ethical issues in Health Promotion' in Katz, J. Peberdy, A & Douglas, J. (eds), Promoting Health, Knowledge and Practice, Hampshire, Macmillan Press LTD 4. Jones, L. & Naidoo, J. (2000) 'Theories and Models in Health Promotion' in Katz, J. Peberdy, A & Douglas, J. (eds), Promoting Health, Knowledge and Practice, Hampshire, Macmillan Press LTD 5. Jones, L. Katz, J. & Sidell, M. (2000) 'Planning health promoting interventions' in Katz, J. Peberdy, A & Douglas, J. (eds), Promoting Health, Knowledge and Practice, Hampshire, Macmillan Press LTD Read More