Person Centred Care Essay
On a female only respiratory ward in the West Midlands a patient was admitted to the ward with chest pain and shortness of breath. Her name was withheld in order to conform with patient confidentiality (Dimond, 2002). Due to being registered deaf, the patient had difficulty com
municating verbally. She had a form of Aphasia resulting in stuttering.
A friend of the family asked if the nurses could note down the procedures for the patient. The friend proceeded to use British Sign Language (BSL) to pass on information when trying to converse with the patient. The BSL use several movements which include hand gestures, lip patterns, fingerspelling and facial expression (National Health Services choices, 2013).
The tissue viability (TV) nurses advised daily leg dressings for ulcerated legs and her personal care and medication were organised. She was kept informed by written notes. All NHS Policies, Procedures and The Code of Conduct within the Trust were followed as protocol. The patient began to refuse any care. It is the right of a mentally competent person to refuse treatment (Dimond, 2005, p142).
After several attempts to change nurses, the patient still refused. This was
done to see if she was more comfortable with one particular nurse. The patient was unable to sleep through the night. The nursing team followed person centred care. The nurses began trying to reason with her to give her consent for treatment.
At this time the patient could have been lying in her own urine and faeces. If her leg was not attended to, further complications could occur. Her leg could become gangrenous and need operating on. All healthcare professionals want to adhere to safeguarding the patient. The Care Quality Commission (CQC) (2014) states “safeguarding means protecting people’s health, wellbeing and human rights, and enabling them to live free from harm, abuse and neglect. It is fundamental to creating high-quality health and social care”. The nurses wanted to respect and think of the dignity of the patient.
Eventually the patient allowed her observations, blood sugar levels and a urine analyses to be done. A urine sample is dipped using a “multiple combination strips – e.g., five tests on each strip (detects blood, ketones, glucose, pH and protein), or seven tests on each strip (tests for blood, ketones, glucose, pH, bilirubin, urobilinogen and protein)” (Henderson, 2004). The sample was sent to microbiology to be investigated into more for underling infection that could be causing her behaviour. At all times information was provided for the patient to make her own decisions and to use all communication sources in place.
Manley et al (RCN) (2011) “Healthcare teams, healthcare provider organisations and governments often articulate an intention to deliver person-centred care. However, achieving it is often challenging and difficult to sustain”. HHHh
This section aims to highlight Holistic and Person-Centred care with reference to the scenario. The paper will look at professional issues in nursing practice, and it is linked with ethical issues. It will then address the importance of effective communication skills. It is including the trust’s policies and procedures, The Royal Marsden hand book, Nursing
Midwifery Council, The Royal College Nursing and Department of Health.
To be able to plan appropriate nursing care the whole of the patient needs to be assessed, physically, medically and psychologically. This is Holistic assessment. All aspects of the patient’s lifestyle, age, gender and how they are feeling needs to be obtained. Whilst the nurse is doing the assessment they must use all of their senses. Therapeutic communication, hearing, visual and touching should be used (Smith, 2012, pp.5-7).
The Health Foundation (2014) states that ‘Person-Centred Care show an important way to make the patient feel involved in their own care’. If the patient has control over their own body and mind, then they will have an understanding of what is happening to them. Person-centred care is in place for the patients, staff and families all to get involved in the planning, care and discharge. It involves compassion which is important in a nurse’s role as the patient enters unfamiliar territory. All staff needs to consider the patients respect and dignity is upheld, with closing curtains, covering up the patient and asking for consent to enter the patient’s bed space.
Person-Centred Care was followed in the scenario. The Doctor and the nurses asked for the family to come in to discuss the care of the patient. The nurses communicated with a friend of the family because the patient’s partner also had a hearing impediment. Then they communicated with the patient and told her it was in her best interest if she allowed the staff to care for her.
The leg began to weep through the dressing. It was over due to be changed. She still refused help. The student nurse who was helping the patient seemed to have a positive impact on her. Price (2006, p.50) states that the person centred care approach needs different frameworks to accommodate different patients. Making sure to look at the patient as an individual. This is what the student nurse did. The patient believed she had previously met with the student nurse.
The patient refused to co-operate with other nurses. The patient was very
co-operative with the student nurse. The student nurse began basic sign language in order to communicate. Then the patient responded, and allowed other staff to look after her. Eventually the patient co-operated, the test results were all fine, and Doctors were not concerned.
Professional issues in nursing practice are linked with ethical issues. In the dictionary the definition of “professional” states “Worthy of or appropriate to a professional person; competent, skilful, or assured” (Oxford 2014). A nurse needs to be professional in their everyday role in work and in their personal life. The Code of Professional Conduct informs a patient what standard should be expected from a registered practitioner. (Burnard. and Chapman, 2004, p1). A competent and caring nurse.
The student nurse noticed the patient was struggling to communicate and had difficulty with other nurses. The student nurse thought she would be professional and use her signing skills to help with communicating.
According to Tschudin (1986) in (Burnard. and Chapman, 2004, p6). Claims that “ethics is caring” and that “to act ethically is to care…to care for ourselves and others”. The healthcare profession can not bring in their own ethics into the hospital; they may have certain religious or moral ideas. On the other hand the patient’s family may have ethical issues. The ethical issues of her understanding what was happening was taken into account by all communication sources in place for her to be in control of her own body and to give her consent.
Medical staff needs to use effective communication with family or friends. They need to be their advocate, to help them to communicate. Active listening is a skill which is also needed to communicate. Look at body language and what the patient is saying. The speed one speaks has to be thought about and the tone. If as much information is given to nurses and doctors as possible then it all helps in the care process. Therefore, communicating with the patient’s friend helped the medical team to understand the health of patient before admittance.
Family are encouraged to stay with the patients, to keep them company and bring in their own belongings to reduce the anxiety of being in strange surroundings. “Good communication helps to build a therapeutic relationship”(Collins, 2009).A nurse is often the one to explain to the patient what a doctor has just said, in a more simple way, to listen to any problems.
All the policy and procedures that are in place at the hospital were followed. One particular policy that was followed is from the hospital hand book of leg ulcer management (2013). This ensures that her leg had been graded, reported and recorded. There had been photographs taken of the leg. Then the leg dressed with all the correct dressings for the grade and type of wound. The Tissue Viability nurses had been to check the wound then advised the nurses what was required to put on the area for healing. The patient was treated as seemed fit by her condition, making sure the antiseptic technique was used.
It is necessary to use knowledge to provide a person and family centred care in The Royal Marsden Hospital Manual of Clinical Nursing Procedures it states that “Poor communication with patients can negatively affect decision making and quality of life” (Dougherty, L and Lister, S (Eds) 2011; Fallowfield et al 2001; Thorne et al 2005,p198). It is not always possible to communicate face to face or to be seen or heard. Perhaps a gentle hand on the shoulder would help. In the case of a deaf person to make sure to stand in a good light so lips can be read. After all a patient has been taken out of their own surroundings and put onto a ward, in a strange bed with strange people around them. A nurse needs to find ways to help the patient to know what is being done without being frightened.
The Nursing Midwifery Council (NMC) is a governing body. The NMC, (2012) states that they have a “vision, mission and values”. Its vision is to make sure nurses and midwives always give their best healthcare to safe guard the public. Their mission is to maintain a register of nurses and midwives making sure they are fit to practice. The education of nurses fits the correct standard. If these are not adhered to then they are dealt with. The
values are for those who need services of nurses and midwifes, they act in the best interest and are open and transparent in their actions and take responsibility. They show consideration and understanding and act with integrity. Also work to high standards and are experts in what they do. Modern health is used and works in partnership with others and provides equality (NMC, 2012, p.3).
The hospital guidelines are “Vision, Values and Strategic Goals”. “They place their patients at the centre of all they do”, “work together to deliver top quality services” and “try to be innovative how they work and create an environment for people to thrive in”(The Royal Wolverhampton, 2014). The student nurse tried to deliver quality service by trying to use her skill in the small amount of sign language she knew.
The Royal College Nursing (2012) state that the “people in your care must be treated as individuals and their dignity must be respected”. The medical team have to reach a certain level and to behave in a certain way. After the entire patient’s life is in their hands. The professional issue of the case is the delivery of care given to the patient was followed to the care plan in place everything was taken into consideration. The Department of Health states that “People who use health and care services have the right to be treated with respect, dignity and compassion by staff who have the skills and time to care for them” (DOH, 2013).
The patient was treated with a high standard of care and alternatives to help with her communication needs were implemented. At a later stage the patient would be discharged from the hospital and transferred under the guide of Community Care Matron. The patient would need to be assessed in order to identify the specific care required. Conclution
From a nursing persective it was evident that a good quality of Person- Centred- Care was implemented. It was taken into account that there were more complicated matters than the patient’s ulcerated leg. The staff worked well as a team, this showed in the way the nurses tried to alternate their care. Everyone worked with the professionalism that beholds a
nurse,competent,skilful and assured. They worked effectively with the communication needs that were in their power to do so. Note taking and using the family and friend for help when signing.The communication problem caused by the patient’s deafness could have been made easer if all staff were trained in BSL. This training must be put in place to allow patient and staff to have better communication.
Burnard,P. and Chapman, C. (2004) Professional and ethical issues in nursing. 3rd ed. Oxford: Bailliete Tindall. Care Quality Commission (CQC)(2014) Safeguarding people. [online]. Newcastle upon Tyne: CQC. [Accessed 14 April 2014]. Available at: . Collins, S., (2009) Building relationships is central to nursing work. Nursing Times.net. [online] 19 June, p.1 [Accessed 17 March 2014]. Available at: .
Department of Health (DOH)(2013) Treating paitents and service users with respect, dignity and compassion. [online].DOH. [Accessed 12 March 2014].Available at: .
Dimond, B. (2002) Legal aspects of patient confidentiality. London: Allen Publishing. Dimond, B. (2005) Legal aspects of nursing. 4th ed. London: Pearson Longman. Dougherty, L. (2011). The royal marsden hospital manual of clinical nursing procedures student edition. 8th ed. West Sussex: Wiley-Blackwell. Health Foundation (2014) Person-centred care: what is person-centred care? [online]. London: [Accessed 27 March 2014]. Available at: . Henderson, R. (2014) Urine dipstick analysis. [online]. Leeds: [Accessed 14 April 2014]. Available at: . Manley,K. Hills, V. and Marriot, S.(2011) Person-centred care:principle of nursing practice ‘D’. 25 (31), pp.35-37.[Accessed 11 April 2014].Nursing Standard [online].Available at: . National Health service (NHS choices)(2013) Commuication sign language.Redditch:NHS [Accessed 11 April 2014]. Available at: . Nursing Midwifery Council (NMC)(2012) Guidance on professional conduct session theme for taught. [Online]. London: NMC.[Accessed 24 March 2014].Available at: .
Oxford Dictionaries (2014) Language matters. Oxford University Press
[online]. [Accessed 8 April 2014]. Available at: . Price, B. (2006) Exploring personal-centred care. 20(50),pp.49-56.[Accessed 16 April 2014].Nursing Standard [online].Available at: . Royal College Nursing (RCN)(2012) Human rights and nursing. [online] London: RCN. [Accessed 12 March 2014]. Available at: .
Royal Wolverhampton NHS Trust. (2013) Leg Ulcer Management. Version 1. Wolverhampton: Royal Wolverhampton NHS Trust. Royal Wolverhampton NHS Trust (2014) Trust’s Vision and Values. [online].Wolverhampton: [Accessed 4 April 2014]. Available at: . Smith, P. (2012) Holistic Assessment Holistic. Assessment skills in nursing [online]. [Accessed 27 March 2014]. Available at .
Person Centred Care Essay
1.1Describe person centred approaches.
The term ‘person-centred care’ does exactly what it says – it essentially places the person at the heart of everything that the care worker and the care setting do. The individual’s needs and emotions are the focal point, and any difficulties are resolved in the interest of the person with dementia (rather than attempting to change the behaviour of the individual). It places the person at the centre of all – thinking, discussions, processes and procedures. The person- centred approach also sees the interactions between the person and different elements within their support systems as being of paramount importance, and therefore places emphasis on supporting the system that supports the person i.e. the family and friends, and other professionals. Person centred approach seeks to view the person with dementia as a whole and considers how the person is influenced by factors beyond the physical changes in their brain.
1.2 Explain why person-centred values must influence all aspects of social care work
Person-centered values must influence all aspects of health and social care work. The Human Rights Act 1998 makes it a law that health and social care should be based on person-centered values.
1.3 Explain how person-centred values should influence all aspects of social care work
If person-centered values become guidelines for health and social care practices. It will definitely help to provide anti-discriminatory practices and help to promote and support individual’s rights to equal opportunities, dignity, independence, choice and safety
2.1Explain how finding out the history, preferences, wishes and needs of an individual contributes to their care plan.
Finding out the history, preferences, wishes and needs of a customer, when writing their care plan, ensures:
Needs and wishes of the customers are met in their daily routine The Care worker has a factual reference point with which to encourage conversation with the customer Helps the Care worker to understand the customer and therefore have empathy which will result in a high level of care
2.2Describe ways to put person centred values into practice in a complex or sensitive situation.
I have a customer who is blind; he lives in the house with his wife. He has 4 children, when we started their care, 3 of his children did not speak to him. The one daughter and their grand daughter took care of shopping (online) amongst other things. His wife went into hospital and the children blame him (never explaining to the care provider how or why this was the case) As the care worker for the customer I naturally have the gentleman’s needs first and foremost. Whilst I was on one of my visits to the customer (this day was usually to receive the online shop and put away amongst other things), I rang my manager as the delivery had not come and time was running out before I went to my next customer.
I requested that they ring the family member and was informed that there would be no delivery as the customer had stated that he did not want any more deliveries. When I spoke with the customer he was not aware of this and asked me what he should do. I spoke with my office and asked if it was ok for me to do his shop as I knew what foods he liked, where he liked his shop to be done and also the fact that he trusted me to do this for him as I was his regular carer. The customer was happy for me to do this and I was able to calm him down talking about things that I knew were of interest to him.
2.3Evaluate the use of care plans in applying person centred values
I believe that care plans are essential in applying person centred values as when dealing with a customer you must have a thorough medical history so you can deal with their needs effectively and also deal with the medical services GP/Paramedics. A full history on the background of the customer is also important, knowing what work they have done, what are their hobbies and interests, family members that they may have and how they may help them in their lives, as it is a conversation point and shows that you are interested in the customer and their lives. Knowing your customer gives you an understanding and an empathy with them.
2.4Explain the importance of monitoring an individual’s changing needs or preferences.
It is very important to monitor and record a customers changing needs or preferences as it will help to make the customer more comfortable and happy that their requests are being heard and acted upon. It is also important because it will let other carers about any changes and if the customer is acting unusual or saying things that do not seem quiet right the this may be due to the fact that they have a UTI or be unwell in some way.
3.1Describe factors that influence the capacity of an individual to express consent
It is crucial for a care worker to be aware and take the matter carefully, because the capability to make decisions among individuals are different. It may look quiet simple o think that people with mental impairment, physical illness or people who have got language barriers, may have a lack of capabilities to express agreement. A care worker will understand how to work sensitively with customers individually and design goals to achieve a successful outcome. The mental capacity act states that every adult has the right to make their own decisions. It must be assumed that they have the capacity to do so, unless it has been proven otherwise. It also states people should be supported in making their own decisions.
3.2Explain how to establish consent for an activity or action.
Consent for an activity or action must done in writing and signed by the customer/family member or a person acting on the customers behalf.
3.3Explain what steps to take if consent cannot be readily established.
Consent (permission) must be given before care can be given to a person. To even touch a person when forbidden, can be considered assault. If there is nobody available when an intoxicated, unconscious or impaired customer requires care, then consent is “implied,” as there is nobody to give that consent. It is assumed that consent would be given by family or that person, if they were able to communicate that.
4.1Explain the principles of active participation
Active participation is a partnership between a customer and the care workers whom support them; it is designed around the customers, letting them choose to live their life as independently as possible
4.2Explain how the holistic needs of an individual can be addressed by active participation.
Holistic means whole so by a customer being involved in active participation it will treat the customer as a whole. Active participation is will enhance the customers life both mentally and physically. They will benefit by being stimulated by the interaction of others and the activity.
4.3Explain how to work with an individual and others to agree how active participation will be implemented.
Firstly you must determine the best way to communicate with the customer you must then determine what activity would be of interest to the customer Contact the relevant professional and arrange a meeting to see how they may actively participate in the activity. A taster session may be given to confirm that the customer is happy to continue. Once the customer is happy with the activity then arrangements for the activity can be confirmed.
4.4Explain how to promote the understanding and use of active participation.
Discussion and encouragement with the customer
Providing useful information and choice.
Using friends and family to encourage
Using appropriate activity
Pier group encouragement
Highlight the benefits of the different activities
5.1Describe different approaches to support an individual to make informed choices.
How you support an individual to make informed choices depends predominantly on the customer’s abilities or inabilities. The main support you can give them is information so they can make an informed choice and once they have that information then they are able to make that decision. If a customer is unable to speak then you can give them visual options so they can show you what interest them and what they would like to do. You can also refer to the care plan for extra information on how to best support your customer with their choices. Some customers may have problems with the memory, therefore discussing their choices and writing them down so they have a reference point.
5.2Describe how to support an individual to question or challenge decisions concerning them that they are made by others.
I believe that giving customers the information they need is vital. You can support them by :-
Offering to attend any meeting they may have to offer moral support
Finding out the information which they may need.
Speaking on the customers behalf (if they are not able to speak)
Making written notes for customers so they have the information they need in front of them.
5.3Explain the consequences of allowing the personal views of others to
influence an individual’s choices
If you allow the personal views of others to influence a customers choice then you may find that:- The customer will not have an interest the choices being made May become insular and feel undervalued as their opinion was not taken into consideration. It may spoil the relationship between the customer and carer. Explain the links between identity, self image and self esteem
Just because someone is older/ill it does not mean that they cannot keep their own identity. When looking after a customer in their own home you are trying as a carer to help the person maintain as normal and unchanged life as possible. Helping them to remain as independent as possible.
6.1 Explain the links between identity, self image and self esteem
The links between identity, self image and self esteem I believe are as follows:- Identity is knowing who you are and what you what identifies you as THE person you are – with that comes self image which again identifies you as THE person who dresses the way you do, wears your hair the way you do etc, with keeping that same identiy and same self image it contributes how you feel about yourself and/or your self esteem. If you are able to keep all of the above in place for a customer then it will benefit them greatly in their day to day life and in any recovery.
6.2Explain factors that contribute to the well-being of an individual
Factors which contribute to the well-being of a customer may be as follows:-
Familiar Surroundings – living in their own homes and surrounded by their possession People contact – daily contact with people especially family members and friends Good Care Plans – an indepth care plan can give the care worker the knowledge on how to look after the customer to a high standard
6.3 Explain the importance of supporting an individual in a way that promotes their sense of identity, self image and self esteem
To enable a customer to live independently in their own home, giving them a sense of identity, self image and self esteem can I believe help in the physical recover of a customer. If they have dementia then it is vital that they keep the identity as familiarity is very important, to make them feel more at ease with what is a very confusing and sometimes upsetting time.
6.4Describe ways to contribute to an environment that promotes well-being
In order to contribute in a positive way, you must firstly know what makes the individual tick Surround the customer with familiar possessions, environment and family and friends. Give the customers the information that they need to feel confident. Enable them to feel confident to question things that make them feel safer
7.1 Compare different uses of risk assessment in adult social care settings
There are various uses for doing risk assessments in an adult social care setting
Accident Prevention: – carrying out work directions to ensure the safety of the customer and others Prevention of injury to individuals:- Ensuring the correct handling of customers so injury does not happen Prevention of injury to workers and other professional individuals: – Again ensuring the correct handling of customers so the care worker or other professionals are not going to put themselves at risk of injury. Description of procedures or steps:- Ensuring that everything in the written to an exacting standard so other care workers will know the correct steps to ensure the safety of the customer and the care worker. To meet Legal requirements – Rightly so there are rules/regulations and guidelines put into place to protect the customers, care workers and other professionals. These are again done, to protect all concerned.
7.2Explain how risk-taking assessments relate to rights and responsibilities.
There are guidelines to follow when doing a risk assessment which are put into place for reasons mainly relating to:-
Prevention of danger and harm
Clear guidance and instructions.
All these are once again for the benefit of customers/care workers and other professionals.
7.3Explain how risk-taking relate to rights and responsibilities.
We all need to take some risks in order to have as full a life as possible. Customers have the right to choose the risks they want to take but have the responsibility not to put others in danger. You have a responsibility to support their choices whilst keeping them as safe as possible.
7.4Explain why risk assessments need to be regularly revised
Risk Assessments need to be regularly revisited as circumstances change i.e. condition of the customer and that of their surroundings.
7.5 Explain the importance of using agreed risk assessment processes to support choice
Using agreed risk assessment processes to support choice are essential as this supports the safety and well being of the customer and that of the care worker and other professionals who come in contact with the customer and their property. It is essential to discuss the risk assessment with the customers as they are the people best placed to make a contribution.
Person Centred Care Essay
It’s important to promote person centred values as no individual is the same and everyone’s needs are different. Therefore we need to show that we have taken into account the individual as it will make them feel more valued and appreciated. It gives a personal touch to our standard of care. Another reason for the importance of promoting person centred values, is to make not just the service user feel valued but also make the families feel that we are taking on board their knowledge and understanding of the service user, in order to give him/her the best care possible.
Consent is giving permission to do something, with an individual either taking part in an activity or accepting some kind of care or treatment.
It is a legal requirement that consent is established before any intervention or caregiving activity takes place. Establishing consent is one way care workers can demonstrate they respect the individual and the individual’s personal dignity.
Consent can be given in a number of ways; verbally, in writing or through actions. You may also have informed consent, such as perhaps by raising an arm to be supported when dressing, and thereby imply consent. Informed consent is given when the individual understands what they are consenting to. If we’re unable to gain consent you will go to the person allocated such as a social worker, next of kin (family) or advocates/solicitor.
Person Centred Care Essay
Individuality- Being unique and not seeing a person with their illness. This is important to make someone feel like his/her own person. Rights- Each person is entitled to their rights and they should be respected. This is important to make sure that everyone is treated the same. Choice- Make sure you choose the right choice and give them the right choice of their carer. This is important so that a person is comfortable with their choice. Privacy- This is respecting another’s privacy. This is important because a person could get embarrassed if their privacy is not respected and have low self esteem Dignity- Make sure you respect someone’s dignity this is important so that they don’t feel embarrassed. Independence- Not doing everything for a person. This is important so that a person is able to do certain things for him/herself Respect- Recognising them as a person.
This is important so that a person is felt like they are being treated fairly no matter what their sex, age or religion is. Partnership- Working with an older person or a vulnerable adult this could be the health services, social services, education services, family, friends or even informal carers. You must be able to explain the best practice which requires social care workers to be able to work in person centred ways reference to the current legalisation such as the government papers and the codes of practice. You also must be able to explain how the individuals receive the best of care once they decide what they want and how they want it to be delivered. Consent in adult social care refers to the provision of approval or agreement, particularly and especially after thoughtful consideration.
Social care workers must gain the consent of an individual so that they are able to help the individual out it is also because of legal implications, for example if someone is going to clean an individual they need permission to do so before they go ahead. A social care worker might gain the consent of an individual by verbally or written confirmation, by asking questions by giving the individual different choices. If a social care worker is unable to get consent due to the individual not being able to express themselves due to a mental illness or a lack of mental capacity or even because they are terminally ill then their consent may be obtained by asking their family or their next of kin.