Reflection and Nurses: the NMC Standards - Essay Example

Reflection is very important for nurses just like it is people belonging to all kinds of professions. Reflection helps nurses “develop a‘feel’ for what they do “practically and bodily so that it becomes part of the knowing process” but cannot always be verbally expressed ‘we know more than we can say’” (countiesmanukau.health.nz, 2013). In this piece of reflection, I have drawn upon an experience I had recently had in delivering care to a patient in an attempt to realize how many of the NMC standards have I met. For the reflection piece I shall be using Driscoll’s reflective cycle (countiesmanukau.health.nz, 2013), a recognised framework for reflection to demonstrate my ability to reflect on my practice. The Driscoll’s reflective cycle has three stages, namely “returning to the situation, understanding the context, and modifying future outcomes” (docstoc.com, 2011). The reflection will concentrate on the difference between aseptic non touch technique in the community setting and within the hospital setting, whilst recognising weaknesses within myself. In accordance with the Nursing and Midwifery Councils (NMC) (2008) guidelines on confidentialality the alias of Mrs B will be used to protect the patients identify. During my community placement, I went with my mentor to Mrs B’s home to redress her wound. Mrs B is a 63 year old lady who suffers from diabetes and has a diabetic ulcer on her left heel. After getting the permission from Mrs. B to enter her home, I introduced myself as a student nurse and asked Mrs B’s consent to change the dressing on her heel. She agreed to this. Consent means agreement that is a fundamental prerequisite of any kind of medical treatment. “Patient autonomy, respect for such autonomy and the right to information underpins this concept of consent” (Daly, 2009, p. 3). Taking consent of the patient before initiating any kind of treatment does not only make the patient feel respected but also improves the patient’s level of involvement and cooperation with the nurse, because the patient has granted his/her consent for the commencement of that treatment. I consulted the patient’s care plan and wound chart to ascertain which dressing was to be used. Reviewing the care plan of a patient is fundamental to the selection of the most appropriate treatment. Care plan not only serves as a therapeutic tool, but also plays the role of a legal record that the care has been given (Turnmore and Thomas, 2000). The care plan also stated that the wound needed to be measured on this visit. I collected all the equipment that was required and took it over to Mrs B’s home who was sitting in an arm chair in her living room. Collecting the equipment that is most appropriate for the treatment of a specific patient is compulsory to avoid frustration or delay in the delivery of care. I then washed my hands in the kitchen with an antiseptic detergent that I had brought along with me to the patient’s home and dried my hands on kitchen roll. “All health care workers must have access to adequate equipment that allows them to decontaminate their hands when required” (Gough, 2010, p. 9). Washing the hands prior to initiating any kind of treatment is a way of ensuring the safety of self as well as of the patient. Protection of health and well-being of the patients is the fundamental responsibility of a nurse (Nursing and Midwifery Council, 2008, p. 2). Mrs B agreed that I could set up my sterile field on her coffee table next to her chair. Under the supervision of my mentor, I opened the dressing pack and put on the apron provided. I opened the dressing and filled the galley pot with sterile water. Next I used alcohol gel to cleanse my hands and put on my gloves. Nurses are advised to wash their hands with an antiseptic handwash agent before as well as after contact with patients that have large wounds or burns (Humphreys et al., n.d., p. 6). I removed the old dressing by putting my hand in the bag provided in the dressing pack and removing the dressing from the leg, turning the bag inside out with the dressing inside. I then measured the wound with the paper ruler provided in the pack. Afterwards I cleaned the wound. Out of the two aseptic techniques i.e. the aseptic non-touch technique and the surgical aseptic technique (Pratt et al., 2007), I put on the new dressing using the aseptic non touch technique. “Aseptic technique is the practice of carrying out a procedure in such a way that you minimize the risk of introducing contamination into a vulnerable area or contaminating an invasive device” (Dougherty and Lister, 2011, p. 110). Aseptic technique is recommended for use by nurses in all sorts of clinical procedures in which the natural defences of the body are bypassed (NHS, 2013). After clearing everything away in the bag provided, I washed my hands again. I then recorded the procedure in the nursing notes and updated the wound chard. I noticed that the wound was larger than on previous occasions. My mentor explained to Mrs B that the wound was not healing as well as expected and asked if she would agree to us referring her to the Tissue Viability Nurse (TVN) for her to review the dressings being used. Mrs B consented to this. This provides an example of informed consent. Informed consent can be defined as “An agreement to do something or to allow something to happen, made with complete knowledge of all relevant facts, such as the risks involved or any available alternatives” (Thomas, n.d.). We then went back to the office and updated the electronic records and I sent an email to refer Mrs B to the TVN. During my placement in the community I encountered a variety of wounds and a vast amount of dressings. To further my knowledge about dressings I asked my mentor and familiarised myself with the Trusts wound formulary. This gave me greater confidence in this area of wound management. Creation of knowledge is an on-going process. “Nurses, by virtue of their licensure status, have a fiduciary duty to continually improve their professional knowledge and skill base” (Brace et al., n.d.). I used this as an opportunity to enhance my knowledge about wound management. By asking Mrs. B’s consent before starting the dressing on her heel as well as before setting up my sterile field on her coffee table, I met Standard A and B of the NMC standards both of which lie in the domain of professional and ethical practice. By reviewing the care plan of Mrs. B before ascertaining the type of dressing she required, I met Standard G of the NMC standards that necessitates the development of a care plan in order to achieve optimal rehabilitation and health on the basis of assessment as well as the current nursing knowledge. This also helped me comply with the Standard O of the NMC standards that imparts the need for a nurse to use and interpret the data considering the ethical, safety, and legal considerations while delivering care. Collection of the required equipment before visiting Mrs. B at her home helped me comply with the Standard F of the NMC standards that imparts the need for a nurse to select reliable and valid tools for the assessment of patient with specific needs of care. By washing my hands and patting them dry with the towel, I met Standard K of the NMC standards that is about demonstrating sound clinical judgment across different kinds of contexts requiring the delivery of care on the part of the nurse. A very fundamental component of Standard K of the NMC standards is to ensure that the practice does not in any way compromise upon the duty of a nurse to provide the individuals with care and keep the public safe. Since I wore the Apron and also cleansed my hands with the alcohol gel before giving Mrs. B the treatment, I also complied with the Standard K this way. I used the aseptic technique while dressing Mrs. B’s wound. The standard E of the NMC standards requires nurses to develop and utilize the opportunities of promotion of the well-being and health of groups, clients, and the patients. I remained very careful not to touch Mrs. B’s wound with bare skin which was why I not only cleansed my hands and wear the gloves but also used the aseptic technique of dressing, thus complying with the standard E. After dressing Mrs. B, I recorded the procedure in the nursing notebook and also updated the wound chart. Since my mentor and I had noticed that the wound had become larger in size, my mentor sought Mrs. B’s consent on being referred to the Tissue Viability Nurse (TVN) for the review of her dressings. The Standard G of the NMC standards requires nurses to formulate and document a nursing care plan with due involvement and consultation of the patients within a framework of informed consent. This provides another evidence of compliance with the Standard G of the NMC standards. Standard H of the NMC standards imparts the need for the nurses to identify relevant changes in practicing new information and passing it to the colleagues. This experience led to an increase in my knowledge of wound management that I received from my mentor, so I also complied with Standard H. Managing wounds within the home setting is different from doing the same in a hospital. While high standards of hygiene at the hospital are monitored and carefully implemented, hygiene conditions in a home setting are often compromising. Mrs. B’s room was not much different. When I arrived at her home, to my astonishment, Mrs. B was smocking and the ash was tripping over her wound’s old dressing. As a nurse, I had no control over the conditions of the room where Mrs. B was being redressed for the wound. Till this experience, I had only performed the aseptic non touch technique in a hospital setting. In hospital the aseptic non touch technique is used for all wound management. This, however, cannot always be delivered in the patients’ own home. Although asepsis it maintained to the best standard not all individuals have high house keeping standards. I have learnt a lot from this experience. I have recognised areas of prejudice within myself and can now reassess my moral values and beliefs, and treat all patients with the same respect and not judge anyone because they have different hygiene standards than me. I have realized that nurses assume a very important responsibility of spreading awareness about keeping high standards of hygiene to others without offending anyone. This requires use of emotional intelligence and a high level of consideration for others’ beliefs and perspectives. Using these skills, I advised Mrs. B to keep the dressing distant from any kind of contaminants including ash of cigarettes, telling her how it could delay the process of healing. Rather than passing instructions, if a nurse tells a patient the reason behind a certain piece of advice, patients tend to understand the nurse and are more likely to take the advice than otherwise. Likewise, when my mentor and I discussed with Mrs. B that she needed to consult the TVN, we did tell her that her wound had become larger. A nurse should always be honest to the patient and should not hide anything important from the patient. This is also important since the patient needs as much information as possible in order to make informed decision. References: Brace, N et al. n.d., Barriers to Attendance at Continuing Nursing Education Presentations, Nursing Research eJournal for Integrated Delivery Systems, [Online] Available at http://www.thepermanentejournal.org/files/nursing/ContinuingNursingEducation.pdf [accessed: 4 March 2013]. countiesmanukau.health.nz 2013, Primary Healthcare Nursing, [Online] Available at http://www.countiesmanukau.health.nz/funded-services/phc-nursing/pdrp/reflection.htm [accessed: 4 March 2013]. 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NICE 2013, Infection: Prevention and control of healthcare-associated infections in primary and community care, NICE clinical guideline 139, INFECTION, [Online] Available at http://publications.nice.org.uk/infection-cg139/guidance [accessed: 4 Mar. 2013]. Nursing and Midwifery Council 2008, The Code, standards of conduct, performance and ethics for nurses and midwives, [Online] Available at http://www.nmc-uk.org/Documents/Standards/The-code-A4-20100406.pdf [accessed: 4 Mar. 2013]. Pratt, RJ, Pellowe, CM, and Wilson, JA et al 2007, epic2: national evidence-based guidelines for preventing healthcare associated infections in NHS hospitals in England, Journal of Hospital Infection, Vol. 65, Suppl 1, S1-S64. Thomas, K n.d., What is Informed Consent?, Nurses for Human Rights, [Online] Available at http://www.nurses4humanrights.org/what-is-informed-consent/ [accessed: 4 Mar. 2013]. Turnmore, R, and Thomas, B 2004, Nursing care plans in acute mental health nursing, Royal College of Nursing, [Online] Available at http://mentalhealthpractice.rcnpublishing.co.uk/archive/article-nursing-care-plans-in-acute-mental-health-nursing [accessed: 4 March 2013]. Read More