Importance of Maintaining Client's Dignity in Nursing - Assignment Example

34 year old Mary White is in your care. She has limited mobility which means that she is unable to walk without assistance. Her chronic and life limiting condition has recently led to a problem with eating and drinking and now Mary is unable to feed herself (although she can take food from a spoon and drink from a beaker) and requires total assistance in this activity. Whilst her body has deteriorated and her speech is limited Mary White’s cognitive function is intact although she is tearful and depressed. It is meal time and you are preparing to attend to Mary White’s nutritional needs. Criteria for Success • Define the concept of dignity and discuss the importance of dignity in nursing care • Discuss how the Code of Professional Conduct (NMC 2008) will guide your actions • What are the issues that need to be considered when helping a patient to eat and drink • What skills would you need to use to encourage Mary to eat and drink • Reflect on how your understanding of dignity in health care may affect your future practice Nurses play an important role in the healthcare industry. It is required of them to take care of difficult and uncooperative patients. Their services are invaluable in the domain of palliative care as well. But in recent years, from being a humanitarian service, nursing has grown into a specialized branch of healthcare industry. The profession of Nursing has undergone several changes over the last few decades. From being an ad hoc service, it has now become a separate field of study in its own right. As a result of growing expectations, new standards of accountability have also been developed and enforced. This is true here in the UK and much of the developed world (Tortora, 2005). This essay will deal with Scenario Two, namely that of patient Mary. By referring to the recently constituted Nursing and Midwifery Council’s Professional Code of Conduct this essay will layout the dos and don’ts for a Nurse in the hypothetical scenario of caring for patient Mary. The Code of Conduct is a comprehensive document that outlines the core responsibilities of Nurses in the United Kingdom. Each aspect of nursing is neatly organized under a separate heading with two further levels of relevant subheadings. The first principle to be followed is stated as “Make the care of people your first concern, treating them as individuals and respecting their dignity”. Here, the key concept is ‘dignity’. In fact, it would not be far fetched to state that ‘dignity’ is at the centre of all nursing activity. In the case of Mary, since she is immobile and has limited speaking ability, it is quite easy to forget that she is a full human being. A testament to her complete humanness is her fully functioning cognition. While Mary might not be able to articulate what she wants or what she feels, she can feel pain, hurt, anger, disappointment, happiness, etc. In other words, the entire gamut of human emotion is accessible to her functioning brain, although recognition of this fact might escape a casual observer at first (Marieb, 2005). As a Nurse adhering to the principles set forth in the Code of Conduct, I would first let Mary know that I treat her on par with any other human being. While taking complete care of a bed ridden patient can at times get tedious and monotonous, I would find ways of circumventing these. The best way of avoiding the monotony associated with nursing a bed ridden patient is by developing a personal bond with her. In the case of Mary, I will express through my words, gestures and general demeanour that I really care about her health and well being. Since Mary’s cognitive functions are fully alright, she can hear and understand what I am speaking to her. As any good nurse will do, I will attempt to win over her confidence and trust through my words and actions. A pedagogic approach would be unsuitable in the case of Mary, as her health condition is not frequently encountered in nursing practice. A more flexible and pragmatic approach would be more suitable. For example, a NMC president Nancy Kirkland says, “Rather than be prescriptive in the Code and set out pages and pages of rules that might be inappropriate and might not arise in different circumstances, we felt it would be better to use this other approach which allows the profession to use their professional judgement, relevant to the situation they are in” (www.nmc-uk.org, 2008). Considering the fact that Mary cannot verbally communicate her likes and dislikes, it is imperative that I understand what and when she likes to eat. As the broader Code of Conduct document spells out, collaborating with Mary would entail making arrangements to meet her language and communication needs. Moreover, I must share information with her in a way she can understand and the information that she seeks about her health is also duly provided her. The limited mobility available to Mary would allow her to nod in approval or disapproval of the food I am feeding her. Before I make preparations for her meal, I would intimate her of the items I have chosen for her meal. I would observe her subtle reaction and understand what she is trying to communicate. It is important that I do not force her to do something she does not want too. While the food chosen by me might adhere to the recommendations made by the nutritionist, I can still exercise discretion in tailoring it to Mary’s preferences. As the Code of Conduct documents indicate, “Patients who have had a stroke may have difficulty in communicating. Nurses need to be alert to this, particularly if these patients are being treated fro and unrelated conditions as their communication need could be overlooked”. (www.nmc-uk.org, 2008) There are issues of practical convenience that need to be considered in feeding Mary. I will make sure that she is comfortably seated and that she assumes a suitable posture for eating food. I would observe if Mary is able to masticate the spoon fed morsel of food. If she has difficulty in chewing the intake properly, then I might resort to a semi-solid meal – one which could be easily swallowed. There are other such contingencies that could arise in the process of feeding Mary. But all times, I would adhere to the recommendations of the nutritionist and all times avoid those food items that had invoked allergic reactions in Mary in the past. It is also important to remember that Mary is showing signs of depression. Depressed patients will not generally have a healthy appetite. Their general lack of interest in life would mean that they are disinterested in food as well. There have been a few cases of injudicious action by nurses in the last few years. There are functional laws within the jurisdiction of the United Kingdom that provide legal recourse to hospitalized patients who are provided negligent or inappropriate care by nurses. The following passage, taken from The Journal, dated November 25, 2005 illustrates this point: “A midwife from South Tyneside Hospital is facing a Nursing and Midwifery Council hearing, charged with not giving appropriate care to two patients between September and October 2003. Siew Seng Bradwell, 51, from South Shields will appear before the council on Monday for the four-day hearing. A spokeswoman for the NMC said yesterday: ‘There are eight charges, all relating to failing to listen to the patient and giving unnecessary intervention’” (The Journal, 2005). This story is particularly relevant to the case of Mary, as she has difficulty in communicating due to her limited speech. As a nurse attending the ailing Mary, I would be eager to find out why she is tearful most of the time and showing signs of depression. To some degree, the chronic and early decline of her health is a contributing factor behind this. But Mary is only 34 years of age and she might not be mentally prepared for her bearing this burden. What she needs at this stage is not just nutritional inputs but also spiritual ones. Using the services of a psychological counsellor is an option that I would definitely use, for when Mary comes out of her Depression, her appetite for food will also return to normal. In addition to availing the services of a professional psychologist, I would also apply basic psychotherapeutic principles that are inculcated in every nurse. Hence, the scope of services that a nurse can offer is very wide ranging. Helen Keleher makes some valid observations in the introduction to her book titled Community Nursing Practice: Theory, Skills and Issues, where she states “Understanding the social basis of health is essential for effective nursing practice in the community because health is much more complex than merely the absence of disease or infirmity. The philosophy of community nursing embraces and promotes the social model of health, which provides a framework for community practice. The social foundations of health include the social context in which people live, work and play, as well as a wide range of social, economic, cultural, environmental and political factors that influence the health of every person and population group. Collectively these are known as the determinants of health” (Keleher, 2007) The case of Mary should also be approached from the aforementioned perspective. As a nursing professional, I am expected to go beyond the text book rules and guidelines. I would try to understand the determinants of Mary’s health before arriving at concrete solutions for her. Many of the health determinants are not easy to quantify, for they are subjective assessments (Jones & Symon, 2000). As a result, the process I adopt to gather Mary’s health determinants should go beyond merely pedagogic ones to include subjective and intuitive assessments. The Environment of Care advice sheet is useful here, as it lays out precautions and actions to be taken in contingency situations. As Mary has shown signs of depression, it is not far fetched to think that she may think of suicide. It is a moot point that she has limited mobility, which would thwart any attempts at suicide. The likely issue is not so much the probability of suicide as the very thought of it. I will have to make sure that the environment in which Mary lives is free of dangerous objects. If Mary is be to cared at her home and not at the controlled environment of a hospital, then the task of making the surroundings safe becomes more challenging. As the detailed document pertaining to environment of care states, “recent changes in the delivery of healthcare demonstrate that a great deal of care now takes place outside of traditional settings. This strategic shift for nursing - from hospital to community – focuses on prevention, and sees patients and the public as the drivers of their care. Nurses and midwives must be aware of the changing needs of the health care settings and the communities they serve, responding to both current and future need.” (www.nmc-uk.org, 2008) Mary’s life limiting condition might mean that she is also on medication everyday. While preparing to feed her, it is important to check for drug interactions of certain food items. For example, some food items will lead to adverse reactions when taken with certain medicines. While the NMC code of conduct document does not elaborate on these nuances, it is expected of a nurse to check for potential drug interactions before deciding on the meal. The Code of Conduct does not explicitly talk about food intake and the attendant precautionary measures, but it describes in length what is required of a nurse when administering medications to the patient. For example, standard 8 of medicines management says the following: “You must contact the prescribing doctor or another authorized physician without delay where contra-indications to the prescribed medicine are discovered, where the patient develops a reaction to the medicine, or where assessment of the patient indicates that the medicine is no longer suitable. You must make a clear, accurate and immediate record of all medicine administered, intentionally withheld or refused by the patient, ensuring the signature is clear and legible; it is also your responsibility to ensure that a record is made when delegating the task of administering medicine.” (Hawley, 2007) Mary has a fully functioning cognitive system, which might lead one to assume that the Mental Capacity Act of 2005 is not applicable in her case. But since she has shown signs of depression, Mary should be treated from the framework set by the Mental Capacity Act. In its introduction to the Act, the NMC website states “the Act provides a statutory framework to empower and protect vulnerable people who are not able to make their own decisions. It makes it clear who can take decisions, in which situations, and how they should go about this. It also enables people to plan ahead for a time when they may lose capacity. The Act is effective in England and Wales and came fully into force in April 2007. It applies to those aged 16 and over with potentially 1.2 million people directly affected and will include those with dementia, learning disability, brain injury, mental health problems and autism.” (www.nmc-uk.org, 2008) Mary’s mental illness is not as obvious some other illnesses such as dementia, brain injury, etc, for which there are telltale signs and symptoms. The evidence for clinical depression is not always clear cut and often a matter of subjective assessment. The fact that she is tearful most of the time is a serious indicator of underlying mental turmoil. There are a few measuring scales that could be used to ascertain the magnitude of Mary’s depression. Something like the DSM-IV standard, which is widely adopted in psychiatric clinics in the United States, could be used for testing Mary (Jones & Symon, 2000). It is important to keep the questionnaire simple and objective, rather than descriptive and elaborate. I will instruct Mary to nod in approval or disapproval for the true/false questions that I would put before her. Based on her answers, I can gain insight into the distressing thought patterns that underlie her depression. Hence, taking care of Mary is not an easy task even for seasoned nursing professionals. Her limited movement and speech adds additional challenges to the task. Yet, the NMC Code of Conduct is a very helpful guideline in dealing with the task at hand. Rather than simply deal with issues of professional ethics, the code also touches upon finer aspects of the nursing profession. It also makes it clear that nursing is much more than a money-earning enterprise, for success as a nurse requires one to display compassion and kindness toward his/her charges. In other words, while the NMC Code of Conduct document should be practiced and implemented in spirit in which it was meant. This way I can make sure that Mary’s dignity is maintained and their self-esteem bolstered in the period of recuperation. The guidelines set out by the code will also keep me in good stead in the years to come. References: Duffy, D. & Ryan, T. (Eds.). (2004). New Approaches to Preventing Suicide: A Manual for Practitioners. London: Jessica Kingsley. Freshwater, D. (2003). Counselling Skills for Nurses, Midwives, and Health Vistors. Philadelphia: Open University Press. Hunt, G. (Ed.). (1994). Ethical Issues in Nursing. New York: Routledge. Jones, S. R., & Symon, A. 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