Within this essay I will be analysing both, the Safeguarding policy and the nursing and midwifery council code of conduct. This essay will include information on both the policy and the code, how they help health professionals and how it is important to have the policy and the code as a student nurse. I will analyse the safeguarding policy and how the policy has been presented, why the policy is there and what other associations help to promote safeguarding. I will analyse the NMC code of conduct and how the policy has been presented, how the code offers support and guidance to health professionals. I will discuss three clinical issues which I have found while I have been on placement, I will discuss how the event occurred and how it has affected myself, the patient and the staff involved. I will discuss how the event has been affected with safeguarding and how safeguarding has been involved or not. The three clinical issues I will be completing will be completed as a reflective account using Gibbs module. I have chosen Gibbs module because I wanted to include my feeling towards the event and I felt Gibbs offered that more than other modules (O’Regan, S. Nestle, D. 2015).
Safeguarding policy, 2015
In this section I will be analysing the implication the safeguarding policy (NHS England, 2015) and how it affected my practice. It is important that when in a health profession role your keep up to date with new policies and to read the newest policies. It is also important that policies are up to date as it gives healthcare professionals a step by step guide on what do if they find themselves in a situation when their patient is unsafe, weather that is at home or in a hospital or a care home. When using a up to date policy will then give the patient the best quality of care.
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The safeguarding policy has been put in place by NHS England to protect, children, young adults and adults in the care of health professionals (Papanikitas, A (2013) The policy that has been put in pace is to ensure the patients no matter their age, all patients are treated fairly and with the high-quality care. Including respecting their human rights and wellbeing and are free from abuse and neglect (Nursing in practice, 2016). Safeguarding has been put in place to prevent an incidence where a patient has come into harm or made to feel disrespected. The NHS has put the safeguarding policy in place for all health professionals, such as Medical Directors of Nursing, NHS England Regional Directors, NHS England Area Directions, Directors of Human resources and General Practitioners (GP) (King’s college hospital, 2018) The way the policy is presented, is it neat and well structured. The information within the policy is informative, easy to read, all information needed is there. The contents page is well presented.
The most important reason we need safeguarding is because the protection of patients from harm and abuse is extremely important in any situations where there is a health profession. If nurses do not whistle blow (A whistle-blower is a person who exposes any kind of information or activity that is considered illegal, unethical, or not correct within an organization that is whichever private or public) (Lewis, P. Goodman, S. 2007). then patients whom are being neglected or abused will continue and nothing will be done about it and the patients’ health will worsen. The responsibility of a nurse when safeguarding a patient is to know how to communicate and know when it is safe to speak up and know who to contact. For instance, a patient being abused in hospital the nurse can either whistle blow to a sister of a ward manager. It is not always easy to know when a person is being abused to know the signs. However, practice nurses have the upper hand as they are trained to know what to look for and how to escalate it properly (National Institute for Health and Care Excellence. (2016).
The direct audience for this policy is mainly health care professionals, the policy can also be used to offer family and/or friends’ information by offering this information it can help the family’s information of what is next to come when someone is been abused or neglected. The safeguarding policy is in place to help direct health professionals and to lead them in a safe direction when needed. The policy offers information of how to handle situations when the health professional is unsure. The policy I have used was published in March 2014 and updated once since there in June 2015 (Nursing in practice. 2016). Most policies are updated either yearly or every fore year, this policy is now due an update to offer more information and guidance to health professionals. When a health professional is caring for a patient who is being neglected or abused The MCA (2015) has set out an legal framework to offer protection to individuals who do not have the capability to make their own decisions, this this type of situation safeguarding decisions should be made by the persons next of kin or a person who is closest to the person and has the persons best intentions. For patients who do have the capability to make decisions, health professionals have to listen to the person and respect their choices, this can sometimes lead to present problems (Nursing in practice, 2016)
Three clinical issue.
In this section I will be discussing three clinical issues I have found while on placement and how it has affected the patient and the staff involved. I be discussing how the event has had an impact on safeguarding and how it may or may not have been used correctly or not up to the standard needed for patients.
Number one – bed sores for patients on hourly turns.
The first issue I will be discussing is a about a patient which, for confidentially reasons put in place by the nursing and midwifery council, will be knows as Betty Smith, an 89-year-old lady with dementia and arthritis. Betty smith was admitted to hospital for been generally unwell and increased confusion, while in hospital Betty Smith started to get grade one bed sores (Hampton, S. Collins, F. (2004) on her back at the bottom of her spine. The nurse looking after Betty Smith decided to put Betty Smith on two hourly turns to relieve the pressure on Betty Smiths back. While all the documentation for Bettys two hourly turns had been completed. However not all of her turns had been complete, some of the staff on the ward had been falsely documenting Bettys turns. With not all of Bettys turns been completed the grade one bed sore started to worsen and become a grade three sore, her skin damaged and broken. When I completed turns for Betty, I applied cream and barrier spray to the sore and made sure better was off her sore as much as I could without making Betty uncomfortable in bed (Hampton, S. Collins, F. (2004). After three days when I began to work with Betty Smith once more, I noticed her bed sore had gotten increasingly worse to a grade fore in which the skin around the sore ha died and the bone was starting to show. Further down her back in the bottom was a grade one sore. After applying cream and spray to both sores, after turning Betty and making has comfortable I documented a new sore and how much the other sore had got increasingly worse. I immediately told the sister of the ward who assessed Bettys sores and completed a form explaining what had happened. When Bettys family came into to visit the sister explained what had happened why the skin came to be being so damaged. Over the following five days until Betty Smith returned home her skin had before a lot healthier and began to heal.
Because of health professionals not looking after Betty correctly by only documenting a turn, Bettys skin became damaged and painful. If nothing had been drought up to the sister I um unsure of the state Betty would have been in when returning home. The condition of Bettys skin will not be the only patient who has suffered in the health care business, unfortunately a lot of patients have been in the same of similar situation, but not all of the outcomes have been the same as Bettys. In the situation I was in I did not know the members of staff that had not turned Betty, but I knew the sores had got considerably worse. Safeguarding for patients in position Betty was in are important to act quickly so no more damage can occur.
My feeling about the situation were guilt, anger, upset and over all hurt to think a health professional had the ability to do something like this to a person. I felt as though Betty had gone through enough of pain due to her arthritis and dementia, why should Betty have the pain of a grade five bed sore when it could have been avoided. The outcome of the situation, the ward got taken to court and chargers were made to the individual.
Number two – One to one patient falling due to low staffing.
The second issue I will discussing is about three different patients, for confidentially reasons put in place by the nursing and midwifery council, will be knows as; Harry Smith, Bart Smith and David Smith.
Harry Smith, a 68-year-old man with lung disease and delirium. Harry has been admitted to hospital due to a fall at home with no witnesses and can not remember how long he was laying on the floor for.
Bart Smith, a 75-year-old man with dementia and a fractured hip. Bart has been admitted to hospital due to becoming increasingly confused.
David Smith, a 70-year-old man with dementia and delirium. David has been admitted to hospital due to suspected fall, David was found lying on the floor at home unconscious.
Harry, Bart and David are all in the same bay in a local hospital, all three men are one to one patient, meaning a member of staff have to monitor them at all times in case of an accident (Cristian, A (2012). While on the ward, it was a busy day, busier than usual, with a full ward and low staff due to illness. I was caring for an elderly lady who was also confused and was a one to one patient. Because of low staffing Harry, Bart and David were not always watched at all times but there was always staff walking around working. During the morning, Bart and David kept on trying to move out of bed or out of the chair by themselves. With this happening, Bard with a fractured hip he is unable to walk without pain. While staff were trying their best to care for the men the staff were so busy, they did not have a minute to collect their thought or to look after the three men. During the afternoon, I was moved to care for Harry, Bart and David. While in the bay I kept a close eye on them and competed all word needed while in the bay, such as; observations of all patients, care charts, fluid balance charts and generally tidying up the bay. While family was visiting, I was able to leave the bay. While off the bay I had my tea and when I returned back to the bay the family had left and Harry, Bart and David were alone, and all seems to be agitated. I discovered David had been incontinent. I asked other members of staff to assist me to help clean David and make him more comfortable and for another member of staff to keep an eye on Harry and Bart. While myself another health professional were caring for David, I heard a loud clash in the bay, when I looked, Bart way lying on the floor with a table on the floor near him and spilt water next to him. I shouted for help and the staff were already there helping. Lucky, myself and the health professional had Cleaned David and he was back in his chair comfy. When I assisted the other nurses with Bart, he was in a lot of pain as it was suspected he has slipped on the water and fell onto his hip. After assessing Bart and deciding what is best to do, the nurses transferred Bart onto a bed and got an emergency X-Ray. After finding out there was no damage to Bart’s hip, he was put on medication for pain relief.
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My feeling during the afternoon, I as weary but felt very confident. During the situation I felt as though I had let Bart down, as though it was my fault. I later found out there was an accident in a different bay resulting in the member of staff has to help another health professional and patient. I spoke to one of the health professionals about how I felt, in a way I felt guilty, the health professional reassured me it wasn’t anyone’s fault, these things happen when there are not enough staff other patients have needs and we cant care for one patient when there are full bays. The outcome of the situation is there was a complaint due to safeguarding submitted by Bart’s family. Safeguarding during this situation was not up to the requirements, low staffing in a common issue in many trusts, unfortunately it is a problem that is not always fixable (By Committee on the Adequacy of Nursing Staff in Hospitals and Nursing Homes, Institute of Medicine (1996).
Number three – Low communication leading to mistakes of medication.
The third issue I will discussing is about a patient which, for confidentially reasons put in place by the nursing and midwifery council, this patient will be known as Tom Smith, a 35-year-old man with a background of UTI’s (urinary tract infection). Tom was admitted to hospital due to a UTI and confusion, while on the ward Tom had a CT scan of his kidney as antibiotics were not easing the pain and health professionals on the ward had queried it to be kidney stones. After having a CT, the results for kidney stones were negative. Tom was then put on a stronger antibiotic. When a health professional was completing medication rounds on the ward, Tom was given a stronger antibiotic called amoxicillin, which was prescribes by the doctors, a few hours after taking amoxicillin Tom began to break out in a rash on his body. The nurses did not know why this was happening. While a health professional was asking the doctor to prescribe a counteract for the rash, the doctor realised her mistake. Tom is allergic to penicillin; amoxicillin has penicillin in it. Tom was having an allergic reaction to the antibiotics which lead to him been in more pain. After a staff meeting with the people involved, including the sister and ward manager. It was decided it was the doctor’s fault for not double-checking Toms allergies, it was then the nurse’s fault second for not looking at Toms allergies.
The outcome of the situation was, Tom spent longer in the hospital because of the allergic reaction. Tom was not upset or angry about the event as he said to me “It was a mistake; the nurses are only human” Tom made a good point it was a mistake of the doctor and the nurse. In my opinion, the doctor is more to blame then the nurse as she should have looked at Toms records to see Toms allergies. However, the nurse as their job has to ask the patient if they have any allergies. My feeling towards the event, I was confused of why Tom did not disclose his allergies to the nurse, and why the nurse did not look at Toms allergies on his boar or on Toms details on the computer. Relating this event to safeguarding, Tom was not protected from harm, safeguarding was not up to the standard to protect a person from harm and neglect. Tom was not treated like other patients; his details were not checked to make staff aware of allergies.
Section three – an analysis of the NMC code
Within this section I will be analysing the Nursing and Midwifery council (NMC) code of conduct and how the NMC code has come into place and why. I will discuss how the NMC code has influenced health professionals and how it will continue to help health professionals through their career, weather the health professional is a student, newly qualified or qualified for a number of years. I will discuss how the NMC code is set out, for example if it set out professionals, makes sense, reads well, and over all a helpful guide. Or if the code is not set out well, for example if it is set out in a way that makes it difficult to read, very cramped, or overall not helpful. I will determine who the NMC is set out to help and why.
The NMC code of conduct has been in place to ensure safety and high-quality care is given to patients (Nursing and Midwifery Council, 2018). The NMC code of conduct has been set out as guidance and support for nurses, midwives and other health professions. Not only health professionals, members of the public are able to access the report to find information and help. The code was first published on the 29th January 2015 and effective from the 31st March 2015. The report has recently been updated on the 10th October 2018 with new information and any new regulations or an update on regulations (Nursing and Midwifery Council. (2015). Since the NMC code has come into play there has still been events occurred in which the NMC standards have not been met by nursing staff. The main even in which this happened was of course the Francis report, 2015 (The Mid Staffordshire NHS Foundation Trust Public Inquiry, 2013), which was because of the events which happened at the mid Staffordshire hospital. After this event happened the NMC updated the code of conduct to a higher standard of care, including what implications could happen if these standards are not met.
Nurses and midwives can use The NMC code to promote safe and effective practice in their workplace, which could be; in hospitals, in a patient’s home, in a care home, etc. The NMC has sent out different guidelines within the code so health professionals know to complete a task. Some of the guidelines include, how to keep a person’s dignity, listening to people and how to respond to their concerns and preferences, how to act in the best interest of patients, how to keep confidentially in a workplace, and many more. Within the code the NMC have includes legal advice and support if an incident were to happen the code offers support and guidance. Overall the NMC offers support and guidance to all health professionals (Nursing and Midwifery Council. (2019).
The was the NMC code is set out professional, the code reads well, the code itself is set out well. Each Chapter includes an introduction and key points with more information for each point.
Overall, this essay has analysed both, the Safeguarding policy and the nursing and midwifery council code of conduct. This essay has included information on both the policy and the code, how they help health professionals and how it is important to have the policy and the code as a student nurse. I have analysed the safeguarding policy and how the policy has been presented, why the policy is there and what other associations help to promote safeguarding. I have analysed the NMC code of conduct and how the policy has been presented, how the code offers support and guidance to health professionals. I have discussed three clinical issues which I have found while I have been on placement, I have discussed how the event occurred and how it has affected myself, the patient and the staff involved.
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