Professional Values, Nursing and Decision Making in Clinical Environment

In the following assignment I will be both reflecting upon and analysing my experiences of professional values and nursing and decision making in a clinical environment. The assignment will discuss my personal experiences in depth, alongside a range of published literature to support and enable me to elaborate on my points.

Throughout the report I will be protecting all patients’ identities when mentioning real life scenarios, in order to maintain confidentiality standards set out by The Nursing and Midwifery Council (NMC, 2018)

My research into nursing and decision making, alongside professional values, will both be discussed in relation to four key components.

They are as follows;

Professional Values-

• Working with an honest and open approach
• Confidentiality
• Having a kind and compassionate manor
• Individuals rights and choices

Nursing Practice and Decision Making-

• Recognising deterioration in a patient
• The use of multidisciplinary teams in healthcare
• My personal pharmacological understanding
• Governing health and safety in relation to Moving and Handling

The justification behind my choice to discuss these topics is that I have found myself especially interested in expanding my knowledge on them theoretically and having experienced them all within my practice placements, reflecting upon said practical experience in order to develop my professionalism.

Professional Values

Professional values guide nurses in nursing care practices, decisions, and solutions of ethical problems and also in interaction with other members of the profession, other health professionals, and society (Alkaya, S.,Yaman, S., Simones J. (2018)

The professional values that are expected of all registered nurses are set out in The NMC Code (2018), this piece of literature has guided me through my research and professional experiences whilst I have been working across a range of adult inpatient areas.

Open and honest approach

The first professional value that I wish to draw your attention to, would be working with an open and honest approach to all dealings within healthcare, focusing upon scenarios where safeguarding principles should be applied. It could be suggested that this way in working will allow the patient to build a trustworthy relationship with yourself, breaking down any barriers to deliver effective, holistic healthcare.

In Gallagher and Hodge’s writing they state that the public wish to be treated with respect and truth telling is a fundamental principle in building trust and rapport with people (Gallagher and Hodge, 2012).

These are the reasons that I ensure I go above and beyond to act in this manner.

During practice placement I have experienced being on the receiving end of undisclosed information regarding a safeguarding issue with the patient and their immediate family neglecting their needs. At the time of this event, I listened to the information being given and explained to the patient that I must disclose this information to a senior member of staff in order to raise the concern, act in the patients best wishes and if necessary, raise a safeguarding case with the appropriate team.

By doing so, I was allowing myself to work in line with The NMC Code (2018) whereby they state it is our duty to share information if you believe someone may be at risk of harm, in line with the laws relating to the disclosure of information (NMC 2018)

By raising this concern, in response to the information given, a safeguarding case was indeed raised and dealt with in the correct manner through investigations. In reflection of this specific case, although breaching confidentiality guidelines, it is important that information be passed across in order to safeguard patients when it is required to do so.

Although a breach of trust in the patient disclosing the information to myself occurred and perhaps the breakdown of a harmonious relationship with the patient could have been a result of my actions, it was of upmost importance that I explained justification behind what my actions were going to be, in an open and honest manor, in order for the patient to accept that the communication of information was in the best interest of their health and well-being.

Confidentiality

Linking in some ways to the first professional value I have discussed, the second professional value I wish to highlight is confidentiality within the NHS.

Whilst representing the NHS, both as a student nurse and when I qualify as a fully registered staff nurse, I recognise how paramount patient confidentiality is as a professional. It is also a legal obligation that information, held with confidence, cannot be disclosed without patients’ consent (Department of Health, 2007).

I have however come to discover through clinical practice placements that in extreme cases, confidentiality laws must be broken if it protects or is in the favour of the patients health and well being.

It is essential whenever we can, to follow the guidelines that are set out in the Data Protection Act (1998). Whilst working in a clinical environment, I have often experiences families being witnessed to difficult diagnosis or information being received from a medical professional. In this case, confidentiality isn’t needed for us to protect the patient. As the patient should have previously given consent for the members to be present. 

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There are however, cases where patients do not wish the information to be available to anyone other than themselves and this can be for a number of contributing factors. The one which I have experienced in a clinical area, is a patient being provided with a piece of information that they do not with family members to receive as they do not wish to cause upset.

At this specific moment, in line with The Code (2015), I respected the patient’s wishes and following in the law and guidelines of confidentiality in the Data Protection Act (1998) and asked if the family would step out whilst we consult with the patient. Acting in my honest and open approach, I then explained to the patient’s family members, that the information being given was sensitive and that the patient had requested to hear the information by themselves.

Referring back to Gallagher and Hodge’s writing where they discuss the idea that the public wish to be treated with respect and the fundamental principle of truth telling, I here both respected the patient’s wishes and  but also acted in an open and honest approach by explaining to the family why I had instructed them to do something.

Reflecting back on the behaviours I adopted in this situation, I believe that the way in which I handled it was effective. I do however question if the patient ever did tell the family the piece of information. Nevertheless, for myself the most important lesson learnt was that the patient’s wishes in relation to confidentiality of their information were successfully met.

Kind and compassionate manor

The third professional value which I would like to discuss is working in a kind and compassionate manor. During my extensive research but also working in a clinical area I have come to realise that the role of the nurse in caring […] is to provide physical or psychological comfort and support (McCabe and Timmins, 2013).

This idea really lit a lightbulb as such, in terms of realisation of the many faces/roles that a nurse adopts in day to day work. McCabe and Timmins’ writing here, I believe, encapsulates the idea of roles that a nurse assumes quite concisely.

To be able to effectively work in a kind and compassionate manor, it could be suggested and supported by their writing that nurses are required to deliver care, comfort and support with a holistic approach.

Understanding, recognition and support from the nurse are key factors in helping the patient cope with their situation themselves. (McCabe and Timmins, 2013)

During my practice, this idea has not only been set in stone in my experience with patients, but also with their immediate relatives, friends or loved ones.

Adopting a kind and compassionate manor was exceptionally important when on clinical placement, a patient had passed away after cardiac arrest on the ward. This was where it was important for me to be able to transfer my professional value of having a kind and compassionate manor, to support the family at this time.

I have found during my research, that it could be suggested that the only time a nurse needs to talk is to answer questions asked and reassure the family and relatives in any way they can (McCabe and Timmins, 2013)

I believe as an individual I hold a strong understanding of how to be kind and compassionate to people, which is invaluable in the nursing industry. The suggestion by McCabe and Timmins in their work enabled me to understand how to approach this specific situation. It could be proposed that at a time like this the use of silence can be key, as also suggested in their work. However, being the person there to support the family was using my kind and compassionate manor to reassure them that they have a professional with them for them to provide reassurance, answers to questions or even small conversation, as and when they required them. 

Being an advocate

One final professional value which I have found is essential to practice is having the ability to be an advocate for positive behaviour in the clinical workplace. I have noticed the need for this role especially in the delivery of personal care to patients.

It could be considered that promotion of patient participation in said activities of daily living, is essential to the development of their healthcare and promotion of independence.

Although it is not exclusive to nursing, advocacy is often a concept that is referred to as an integral role of nursing (Hanks 2010). During my professional practice, I have used the role of advocacy to positively encourage patients’ involvement in their own care.

 Enabling a patient to be directly involved not only promotes their independence but also positive health and well-being via them understanding that they are of a high importance to their own care. An advocate is a person who encourages and helps others in developing their confidence and self-esteem (McCabe and Timmins 2013).

When I had asked the patient is they would like some assistance with their cleansing, and faced with refusal of cleansing at all. I promoted the idea to the patient that positive hygiene is an integral factor of promoting their dignity and respect.

I have however, considered the information provided in the Human Rights Act (1998) regarding the right to make our own choices in argument with the importance of the above conversation.

The development of confidence and self-esteem via my advocacy and promoting the reasoning behind my suggestion of cleansing to the patient, I have concluded is essential in aiding the patient to use their human rights, to hopefully allow them to determine an informed decision.

Nursing Practice and Decision Making

Recognising deterioration

It is important within nursing practice that I continue to develop my knowledge and understanding through the clinical experiences which I experience. It is a specification of The Code (NMC, 2018) that we regularly take part in learning and professional development activities that maintain our competence and improve practical skills in performance.

I believe my extra reading surrounding the National Early Warning Score system (NEWS) used within the NHS has provided me with vital knowledge when collecting observations such as blood pressure, heart rate, respiration rate, temperature, pulse and oxygen saturation levels. The sensitivity of an early warning score system is how good it is at detecting deteriorating patients (Adam, Odell and Welch, 2010) meaning that when taking observations, the system allows us to have clear boundaries on what abnormal results would present like.

Whilst working on a female inpatient unit and using the NEWS system, I had observed a patient whose respiration rate and pulse were abnormally high. Changes in respiratory function have been recognised as one of the most important early signs of deterioration. (Adam, Odell and Welch, 2010).

Working within my competency (NMC, 2018) I was able to arrange for further emergency assessment to be provided for the patient who was showing signs of deterioration. Through wider investigations and following through on the patient’s journey, I was able to learn more about the increasingly common illness that she had contracted, sepsis.

Sepsis is often described as ‘’blood poisoning’’ and is a systematic infection (Angus and Poll, 2013) and this lady has developed the fast acting infection and was presenting this through the deterioration of her observations. I managed to remain calm in the situation, asked for and obtained assistance from other staff members before taking further action.

With support of my mentor and of the other staff members involved in the patients care, I continued to assess the patient’s observations in order to identify any further signs of deterioration that may be present. By doing so and implementing the discussed plan of action, I was able to ensure I delivered effective and safe care. (NMC, 2018)

Throughout my experience with this patient, my knowledge upon what is abnormal and the way we can recognise deterioration of patients in our care has been expanded a great deal. Moving forwards, it has given me the confidence to be able to question the way a patient is presenting if I am not happy with something and gain advice from the rest of the team.

Use of multi-disciplinary teams

In nursing practice it is essential that the use of a multi-disciplinary team is in order. Multidisciplinary working involves appropriately utilising knowledge, skills and best practice from multiple disciplines and across service provider boundaries, e.g. health, social care or voluntary and private sector providers to redefine, re scope and reframe health and social care delivery issues and reach solutions based on an improved collective understanding of complex patient needs (NHS 2014)

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Whilst working on a ward that cared for patients with dementia, I had recognised one patient who would usually actively participate in activities had started to state that she required the toilet more frequently. This would involve the patient walking to the toilet, where she would refuse that she had finished and sit in the isolated cubicle for lengthy amounts of time.

Through investigation into this, I had recognised in her care plan that this was a behaviour that staff should be aware of as this patient regularly does this and is a concern for her well-being due to her condition. Through my research into how working in a multi-disciplinary team is beneficial in healthcare, in the next meeting that was held I was able to document that this behaviour was present and a discussion regarding patient observations being of a higher level was had.

Working in a multi-disciplinary team could be very useful in bringing about the changes needed to develop a high quality and patient-centred health care service. It is where health care staff are collectively accountable for the quality of the patient care. (McSherry and Pearce 2011)

Recognising what The Code (NMC, 2018) states about the use of multi-disciplinary teams. I find it exceptionally beneficial as I was able to understand and respect the range of expertise and gain contributions to evaluate the current delivery of care and further enhance the patient’s level of observations to monitor their condition.

It means that all healthcare professionals are able to collaborate and share their knowledge and area of expertise to promote a holistic, person centred health care service to all.

Pharmacological understanding

For most individuals who are entering an undergraduate degree in the medical profession, the subject of pharmacology is a completely new idea to them. This being applicable to myself I found the idea of administering important medications, under direct supervision, to patients to be an incredibly daunting act to perform. Whilst working on placement, along with the most up to date version of the British National Formulary (Joint Formulary Committee, September 2019- March 2020) I have been able to undertake dispensing of medications to patient. Doing this under direct supervision of a registered nurse allowed me to gain confidence in the behaviours that I was carrying out to be correct.

During my experiences with dispensing medications often there was a need for me to review the correct medication to expand my knowledge on its effects  (Joint Formulary Committee, September 2019- March 2020), calculate the dosage for that patient in line with their care plan and without deviation from their prescribed medication chart (NMC, 2018). One medication task that I learnt specifically whilst on placement was how to deliver a subcutaneous injection.

On placement, after completing the task, I correctly disposed of the needle into the yellow sharps bin. This was to be done in line with the local trusts policies but also safeguarded the health, safety and well-being of myself, colleagues and indeed other patients (NMC, 2018).

Throughout my research I have found in a research investigation by The Royal College of Nursing (RCN, 2009) that half of the staff who undertook a questionnaire by the RCN regarding needle stick injuries, half had encountered a needle stick injury after they had been admistering drugs to a patient. I see this of vital importance when working within healthcare to follow all protocols regarding Pharmacology to promote safety in the work place.

Governing health and safety

Conclusion

Throughout this writing I have reported on my own experiences in relation to the topics chosen, Professional Values and Nursing Practice and Decision Making. I have been able to develop an informed knowledge and understanding on the importance of my research through published literature supporting said experiences.

By exploring the topic Professional Values, I have been exposed to my strengths and weakness’ which has enabled me to work in a reflective manor and alter my practice. Researching Nursing Practice and Decision Making has also allowed me to understand the things that I will be responsible for as a nurse, it has allowed me to understand the way in which nurses act in a professional manor and combine their knowledge with others to deliver safe, effective and person-centred care.

Ultimately, I have been able to develop a recognition of favourable behaviours within practice that should be followed through my personal experiences and literature evidence. They have continually allowed me, and will continue to allow me, to be able to make informed decisions when working as a nurse.

References

• Adam, S., Odell, M. and Wech, J. (2010) Rapid assessment of the acutely ill patient.  West Sussex, John Wiley & Sons Ltd.
• Alkaya, S., Simones, J. and Yaman, S. (2018) Professional values and career choices of nursing students. Nursing Ethics. Vol.25 (2) pp.234-252.
• Angus, C. and Poll, T. (2013) Severe Sepsis and Septic Shock. Journal of Medicine. 2 (9), pp.849-851
• Data Protection Act (1998) [online] Available at: http://www.legislation.gov.uk/ukpga/1998/29/pdfs/ukpga_19980029_en.pdf [Accessed on: 15th October 2019]
• Department of Health (2007) NHS: Information Governance: Guidance on Legal and professional obligations [online] London COI: Available at: https://www.gov.uk/government/publications/nhs-information-governance-legal-and-professional-obligations [Accessed on: 15th October 2019]
• Gallagher, A. and Hodge, S. (2012) Ethics, law and professional issues: A practice- based approach for health professionals. Basingstoke, Palgrave Macmillan.
• Hanks, R.G. (2010) The medical-surgical nurse perspective of advocate role. Nursing Forum.  Vol. 45 (2) p.97-107
• Human Rights Act (1998) [online] Available at: http://www.legislation.gov.uk/ukpga/1998/42/contents [Accessed on: 18th October 2019]
• Joint Formulary Committee. (September 2019- March 2020) British National Formulary 78 (online) London: BMJ Group and Pharmaceutical Press [Accessed on: 29th November 2019]
• McCabe, C. and Timmins, F. (2013) Communication skills for Nursing practice (2nd edition) Basingstoke, Palgrave Macmillan
• McSherry, R and Pearce, P. (2011) Clinical Governance: A guide to implementation for health care professionals. Oxford, Wiley Blackwell.
• NHS England (2014) MDT Development: Working toward an effective multi-disciplinary/ multi-agency team. [electronic resource] Leeds, NHS England.
• NMC (2018). The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. [electronic resource] London, NMC.
• RCN (2009) Needle Stick Injuries [online] London: Royal College of Nursing. Available at: https://www.evidence.nhs.uk/search?g=shares+needlestick+injury Accessed: 29th November 2019.