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How did the nurse act professionally? (Cesci)

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How did the nurse act professionally? (Cesci)

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Student
1. Took handover to gather further knowledge about the patient and understood that she had had a neck fracture following a recent fall.
2. Curtains were drawn to maintain the patients' dignity.

Mentor
1. Noticed that patient was anxious and offered her hand in order to reassure the patient and make patient feel more comfortable. This resulted in patient appearing to feel less nervous.
2. Mentor asked patient if they were experiencing any pain. Therefore allowing patient to express themselves.
3. Mentor explained to the patient the process of needing to move patient therefore allowing patient to understand what was going on.
4. Mentor ensured that appropriate equipment was used to move the patient e.g. PATSLIDE and slide sheets.
5. Mentor offered additional medication that was prescribed.
6. During the process of moving the patient, the mentor ensured that consistently provided an explanation to the patient. This therefore kept the patient informed of what was happening.

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Beneficence - the nurse acted in a compassionate way, offering her hand to the anxious patient to show her support and to provide comfort. Also, the nurse promoted the patients' dignity by drawing the curtains around them as they approached the bed side and before transferring the patient onto the bed, to give the lady privacy.
Non-maleficence - the nurse did not want to put the patient in any harm and did not want her to be in any pain therefore, she asked if the patient wanted pain killers before having to transfer from the trolley onto the bed.
Autonomy - Linking into this, the nurse promoted autonomy with regards to the patient wanting extra pain killers. The patient was offered the pain killers and was told why it would be beneficial for her to have these before moving however, the patient declined the offer and this was respected by the nurse.
Principles of totality and integrity / veracity- the nurse was providing good practice when explaining to the patient and to the student nurse everything that they were going to do with regards to moving the patient using a patslide and slide sheets. The nurse was aware that the manoeuvre would be painful for the patient and therefore was completely honest about how painful it may be so decommended that the patient should have taken pain killers to help with the pain.
Nurse on course learning. 2018. 6 key ethical principles of nursing. Available at: https://resources.nurse.com/6-key-ethical-principles-of-nursing. [Accessed: 9th September 2018]

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1. Moving the beds - the student and the nurses could have found alternative ways to make Pauline feel more comfortable in the swapping of beds by following protocol and abiding to manual handling policies. A political agenda that could be linked to this is Cardiff University Clinical Skills 'Taking care of your back - Manual Handling' as this is in place to raise awareness of how important it is for nurses to look after their backs and recognise what risks there are when handling patients and objects within a clinical area and finding the safest solution to deliver safe practice.

2. Dignity and Respect - by the student and the nurses closing the curtains around Pauline, this shows that they care about preserving her dignity making her feel as reassured and comfortable as possible. A political agenda that is linked to this is 'NHS Wales - Standard 10 Dignity and Respect Governance E-Manual' which is in place to make sure that patients needs and wishes are given the appropriate attention and treated with a professional manner that takes into account their dignity and respect. The key parts of this agenda include respect, dignity, privacy, self-esteem and autonomy.

3. Denying Medication - by Pauline rejecting further medication the student and nurses were not allowed to force her. The NMC Code states that the patient is the priority and ultimately has the right to decide what type of care and treatment they want. This means that patients get to have the last word in what happens with their own healthcare plan. A political agenda that could be linked to this is 'NHS Wales Medication Management' which is in place for nurses to manage medicines and prescribe medication to patients to safely deliver the improvement of health for patients.

Cardiff University Clinical Skills Taking care of your back - Manual Handling [Online] Available at:
https://learningcentral.cf.ac.uk/bbcswebdav/institution/Medic/Undergraduate/Manual%20Handling/src/docs/manual_handling.pdf
[Accessed 10 September 2018]

NHS Wales Governance E-Manual. Standard 10: Dignity and Respect. [Online] Available at: http://www.wales.nhs.uk/governance-emanual/standard-10-dignity-and-respect
[Accessed on 12 September 2018]

NHS Health in Wales. Medicine Management  [Online] Available at: http://www.wales.nhs.uk/medicinesmanagement
[Accessed on 11 September 2018]

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1. By taking handover from the previous staff members, the student ensured that she knew more about the patients condition and clarified that the patient, Pauline, had a neck fracture and understood the cause of it. Accurate handover has been proven to improve the safety and quality of care given (Chaboyer, W. 2009).
2. The mentor realised that the patient was feeling anxious, and appropriately used the non-verbal communication skill of touch in an attempt to reassure Pauline. Knapp and Hall (2013) highlight how gestures, such as touch, influence a conversation - therefore the mentor positively influenced the conversation with the use of touch.
3. PATSLIDES and slide sheets on were used when moving the patient from the ambulance trolley to the bed. This abides to NMC Code of Conduct (2015) guidelines which not only highlight the importance of reducing avoidable injuries to the patient, but also ensuring that staff members are not hurt.
4. It is clear that the mentor consistently ensured that they were abiding to evidence based practice, as when they offered Pauline further analgesia, the medication was prescribed. Benna, J (2011) highlights the importance of abiding to given and signed prescriptions, arguing how if one fails to adhere to their set prescription, negative consequences can affect not only the patient but also the healthcare system. Failing to adhere to prescribed medication dosages includes taking more or less medication that needed. It is therefore vital that the mentor ensured that the patient could take further analgesia, thus eliminating the risk of medical errors which could cause harm to the patient.

Chaboyer, W. (2009), Bedside Handover, Journal of nursing care quality, 2, 24, 136-142

Knapp, M. Hall, J. 2013, Nonverbal Communication,Berlin, De Gruyter, p.12

Nursing and Midwifery Council, 2015, The Code of Conduct, p.7

Benna, J. (2011), Patient Medication Adherence: Measures in Daily Practice, Oman Medical Journal, 3, 26, 155-159

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The nurse ensured that she had taken handover from the previous nurses who had worked the shift. This allows her to have the most up-to-date information on the patients on that ward. This is safe practise as the nurse knows current information on the patients which will allow her to provide the best care possible. This relates to principle C of the RCN (2018) 'to reduce the risk to patients by ensuring they are safe'.

Patslides and slide sheets are used for moving patients safely, in this case from the ambulance trolley to the bed. It safe for the patient and for the nurses/HCA's moving them. Following NMC(2015) guidelines it ensures injury to patients is reduced.

Medication was administered to the patient as prescribed. This is safe practise because the nurse is administering the safe amount of medication that the prescriber has seen fit for the patient.

By the mentor and the student talking to the patient continously they've developed a relationship in which the patient feels safe and secure. The patient is aware of what is happening which is a safe way of caring for an individual.

Royal College of Nursing. 2014. Principles of Nursing Practise. [ONLINE] Available at: https://www.rcn.org.uk/professional-development/principles-of-nursing-practice. [Accessed 10 September 2018].

Nursing Midwifery Council (NMC). 2015. Read the Code Online. [ONLINE] Available at: https://www.nmc.org.uk/standards/code/read-the-code-online/. [Accessed 10 September 2018].

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1. The student was asked to help admit Pauline by her mentor-
The NMC Code of Conduct (2015) recognises that the nurse needs to be accountable for their decisions which also means that tasks and duties must only be delegated within the person's scope of competence .

2.  Handover-
The Quality Improvement Clinic (2015) aims to achieve effective information transfers of clinical patient material during these shift changes. By using a handover policy, patients safety can be ensured and clinical risk minimised. As the NMC Code of Conduct (2015) instructs nurses to maintain the safety of those in their care, handovers can give staff the opportunity to communicate any problems and concerns  which ensures everyone knows what's going on and  prevent jobs from being missed /repeated .

3. Nurse introducing herself-
The ‘Hello my name is’..... campaign (2013)  has been implemented as a policy and  has been widely promoted throughout a wide range of health and social care settings. The campaign  is focused on reminding staff to introduce themselves properly as it  can put patients at ease and help them feel confident with who they are meeting.

4. Explaining to Pauline what was happening when moving her and when offering medication in order to gain informed consent-
NHS (2017) states that consent from a patient is needed regardless of what type of procedure /examination/ test they undergo. This can be obtained by an explanation by the clinician who is performing/ assisting  in the procedure.

5. Correct manual handling- making sure trolley was directly along side the bed- using PATSLIDE and slide sheets
Legally employers are obliged to provide safe working environments for their staff  as under the Manual Handling Operations regulations (1992) employers  are required to reduce the risk to the lowest level reasonably practicable and provide training for staff on safe and healthy practice. Individual risk assessments also need to consider the specific moving and handling needs (e.g. help needed, specific equipment needs and number of staff needed to support the patient) to ensure the safety of staff and the patient/service user (NHS 2018) .

6. Drawing the curtains-
The Derby Teaching Hospitals NHS (2016) Trust policy ensure procedures are put into place for maintaining the privacy and dignity of patients including children and young people .

Quality Improvement Clinic .2015.  Design, implement and measure: A guide to improving transfers of care and handover .  Available at: https://www.england.nhs.uk/signuptosafety/wp-content/uploads/sites/16/2015/09/safe-comms-design-implmnt-meas.pdf  [Accessed 9 September 2018].

Hello My Name is . 2013. A campaign for more compassionate care. Available at: https://www.hellomynameis.org.uk/ [Accessed 9 September 2018]

NHS. 2017. Consent to Treatment. Available at: https://www.nhs.uk/conditions/consent-to-treatment/ [Accessed 10 September 2018]

Derby Teaching Hospitals NHS . 2016.  Trust Policy and Procedures for maintaining the privacy and dignity of patients including  children and young people . Available at www.derbyhospitals.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=8957. [Accessed 10 September 2018].

Royal College of Nursing.  2018.  Moving and handling. Available at :https://www.rcn.org.uk/get-help/rcn-advice/moving-and-handling . [Accessed 10 September 2018].

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The article "Do Patient's Understand?" (Graham and Brookey, 2008), explores the importance of delivering a clear explanation of a patient's medical treatment to them in person so it is easier to understand the reasons for and the implications which may occur because of it. This is clearly done by the nurse mentor throughout the admission.

The mentor applies the use of appropriate touch after gaining implied consent from Pauline to help reduce stress and reassure, important to gain consent in case culture of religion prohibits the use of touch, (Rosdahl and Kowalski, 2008).

The mentor was correct to offer medication to Pauline which may have managed the pain she was experiencing or about to during the transfer, even though the patient declined. This is supported by "A Guide to Improving the Care of Patients with Fragility Fractures", (Kates and Mears, 2011)

Graham and Brookey (2008), Do Patient's Understand?, The Permanente Journal, 12 (3), pp. 65-67

Kates and Mears (2011), A Guide to Improving the Care of Patients with Fragility Fractures, Geriatric Orthopaedic Surgery and Rehabilitation, 2 (1), pp.5-37

Rosdahl and Kowalski (2008), Textbook of Basic Nursing, US: Lippincott Williams and Wilkins