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This essay will demonstrate an understanding of the personal and professional values required of an accountable nurse and evaluate the importance of using evidence base in nursing practice. This essay will also include the understanding of the guidelines, principles, ethics and codes used in nursing thus the 6 c’s and the NMC Codes (2018) while demonstrating how to deliver evidence based care in relation to Mum ‘Harriet’ from the ‘The Family’ case study. From the case study, Harriet is demonstrated as a woman with 3 main roles at home. These are a mother, wife and most recently a carer to her father who suffers from dementia. She is also currently on maternity leave from her job as a primary school teacher. Harriet has a diagnosis of post-natal depression and also going through grief from the recent loss of her mother. Delivering timely holistic care and support to mum would be critical as she is key in this ‘The family’ setting. The theme chosen for this assignment is NMC Code (2018) Practice effectively. The two chosen standards are standard 6 “ Always practice in line with the best available evidence and standard 8 “Work co-operatively”.
The Code is used to guide nurses on the register to practise professionally and effectively “Those on our register can use it to promote safe and effective practice in their place of work.” NMC Codes (2018). When we look at being an accountable nurse we have to understand the meaning of nursing as a profession. According to the International Council of Nurses (ICN 2002) “Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well, and in all settings.” This means it would be unethical for a nursing profession to determine care delivery in reference to a patient’s social and demographic circumstances. Nurses have a responsibility to be morally, ethical and legally accountable for their actions and in decisions they make while delivering care. This means they have to work within their competence as outlined by the NMC Code.
According to the NHS “Postnatal depression is a type of depression that many parents experience after having a baby. It's a common problem, affecting more than 1 in every 10 women within a year of giving birth.” Harriet has already been diagnosed with postnatal depression. The diagnosis would be followed with a care plan which would be beneficence to Harriet. Autonomy is expected to be used while developing a care plan for Harriet. This is the ethical decision making process where a patient has a right to retain control over his or her body. The Mental Capacity Act 2005 also offer guidance and states that a service user should be treated as though they are able to make decisions not unless all avenues to guide him or her have been explored without success. If all of them fail then the Act provides a guidance to act in the best interest of the service user or patient. The care plan would go through the nursing process of assessment, diagnosis, planning, implementation, and evaluation.
Harriet has factors that would make her deviate from the care plan as mentioned earlier. She has roles within the family that may take priority in her day to day life like being the carer to her father. A student nurse would practice effectively by providing guidance within her competence in order to assist or sign post Harriet in the right direction to achieve the goals set out in the care plan. According to Nice guidelines “Women can be concerned that the mental health problem may have a negative impact on the wellbeing of their baby. This can exacerbate an already disabling mental health problem.” Apart from the baby, Harriet has other children she is caring for. Prioritising a person centered timely holistic care delivery for Harriet would be paramount in order to enable her to care for herself and her children. Evidence based on research shows that a significant number of women with schizophrenia lose custody of their children (Howard, 2005).
We learn from the case study that one of the children has special needs and has recently been discovered to have bruises. This is a potential safeguarding concern and therefore there is need to follow procedure and work co-operatively with other disciplines in order to meet the family’s needs. NMC Code 8.1 refers to respecting the skills, expertise and contributions of colleagues by referring matters to them when appropriate. In this instance sharing of information with relevant multi disciplines like social workers in order to safeguard the children when there is a care concern is important. Section 17 of the Children Act 1989 states that local authorities have an obligation to safeguard and promote the welfare of children and wellbeing within their families. This is by maintaining clear and effective communication within care givers and colleagues whilst also involving Harriet as this matter concerns her family.
Harriet is also a carer for the dad who is vulnerable as he is diagnosed with dementia. This situation could be concerning as Harriet may not have the capacity mentally and the time, to be in a position to provide the level of care needed for her father as her attention should be in getting better herself. Again NMC Code provides guidance in this scenario in code 8.5 “work with colleagues to preserve the safety of those receiving care” and in 8.6 “share information to identify and reduce risk” The Care Act 2014 also states that the wellbeing of service users should be promoted by protecting them from abuse and neglect. In this situation, an accountable nurse would escalate the situation and report any concerns in order to minimise risks or prevent negligence. An assessment and evaluation of the situation would be carried out whilst involving the father and Harriet in the decision making of what would happen next if referrals are being made. The assessment should be mindful of the facts surrounding the presenting problem. Harriet is also grieving the death of her mother, so is the father the loss of his wife. It is vital that health care staff are able to understand how a service user’s current presenting problem fits into their previous experience (Steve Trenoweth et al., 2017)
In order to practice effectively, Jane Cummings chief nursing officer engaged with over 9000 nurses and birthed the 6cs. These are care, compassion, competence, communication, courage and commitment. This core values and attributes enables nurses to engage with patients with compassion while providing care to the best of their knowledge and competence (Jane Cummings NHS England 2014). Caring in nursing is practicing to keep the patient safe and preventing them from harm by proving high quality care. Therefore, Harriet can be made to feel valued and cared for by involving her in the plans and implementations of care for her and that of her loved ones. Listening and engaging with the patient and empathising with their situation can helps in creating therapeutic relationships. “In broad terms, the therapeutic relationship has been conceptualized as both the cause of change as well as the vehicle for change, and active engagement of clients in their care and treatment is seen as central to achieving successful outcomes and recovery.” (I Norman & I Ryrie 2013) This relationships should be built while maintaining professional boundaries. Compassion is given by preserving and giving her the dignity she deserves as a patient. Principle A from the Royal College of Nursing states “Nurses and nursing staff treat everyone in their care with dignity and humanity – they understand their individual needs, show compassion and sensitivity, and provide care in a way that respects all people equally (RCN Website)
Practising within your level of competence as a care provider in nursing is key. Principle 8.5 in the NMC Code also provides guideline in regards to this. If there is a procedure in the care delivery that a student nurse or nurse is not confident or competent in carrying out, they should not engage in doing it. In this instance, they should communicate and share clearly to their colleagues to avoid risks. Good nursing practice is non maleficence. According to NICE guidelines women with postnatal depression have frequent contact with healthcare providers and therefore, if competent in detecting mental health problems, these provides the health care deliverer with plenty of opportunities for early interventions and in making ethical decisions. Harriet would therefore have health visitor appointments and vaccinations appointments for the baby hence providing opportunity to communicate and engage to know if there are any concerns. There would be a district nurse as mentioned in the case study who would regularly see Harriet’s father in his package, who would or should have the opportunity to see if everything seems or feels right.
An accountable nurse has to have the courage to report incidents accurately. This attributes links to the NMC principle 8.7 “be supportive of colleagues who encounter health or performance problems. However, this support must never compromise or be at the expense of patient or public” If there are mistakes, the ability to admit wrong doing and apologising and starting again given the opportunity shows professionalism in nursing practice. NMC Code also states nurses, midwifes or nursing associates all have a professional duty to report and raise concerns in their workplaces which put people in their care or the public at risk. According to the Royal College of Nursing principle C states that “Nurses and nursing staff manage risk, are vigilant about risk, and help to keep everyone safe in the places they receive health care.” (RCN) This raises the opportunity to reflect and learn from the mistakes made so that they can be avoided in future.
In conclusion, the NMC which governs registered nurses midwives and nursing associates promotes the use evidence base practice to identify clinical problems and used to improve clinical practice. “EBP is more than using findings from research. It is the integration of this evidence and knowledge to current clinical practice, for the use at local level, ensuring that patients receive the best quality care available.” (J Baker et.al., 2016). The evidence is based on patient experiences and their expectations, clinical experience as well as local or organisational influences. This assignment has outlines the importance of the nursing 6 C’s and how they can be implemented in providing care. It has also linked the NMC codes and their guidance and professional attributes towards being an accountable nurse.
- Baker, J., Linsley, P. and Kane, R. (2016). Evidence-Based Practice for Nurses and Healthcare Professionals. Third Edition ed. Sage.
- England, N. (2019). NHS England. [online] England.nhs.uk. Available at: https://www.england.nhs.uk/.
- Howard, L.M. (2005). Fertility and pregnancy in women with psychotic disorders. European Journal of Obstetrics & Gynecology and Reproductive Biology, 119(1), pp.3–10.
- Legislation.gov.uk. (2014). Care Act 2014. [online] Available at: http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted.
- Legislation.gov.uk. (2019a). Children Act 1989. [online] Available at: https://www.legislation.gov.uk/ukpga/1989/41/contents.
- Legislation.gov.uk. (2019b). Mental Capacity Act 2005. [online] Available at: https://www.legislation.gov.uk/ukpga/2005/9/contents.
- NICE. (2019). NICE | The National Institute for Health and Care Excellence. [online] Available at: https://www.nice.org.uk/.
- Nmc.org.uk. (2018). The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. [online] Available at: https://www.nmc.org.uk/standards/code/.
- Norman, I.J. and Iain Ryrie (2017). The art and science of mental health nursing : principles and practice. Maidenhead: Open University Press.
- The Royal College of Nursing. (2019). RCN - Home | Royal College of Nursing. [online] Available at: https://www.rcn.org.uk/.
- Trenoweth, S. and Moone, N. (2017). Psychosocial assessment in mental health. Los Angeles: Sage.
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