2: Principles of adult nursing

Section 2 Principles of adult nursing




2.1: Legal issues


2.2: Health and safety


2.3: Professional practice issues


2.4: Ethics in nursing.



2.1 Legal issues



Property


In the rush and excitement of care, it is vital not to neglect or mislay any patient’s property. Often the patient/family does not realize something is missing until discharge, which could be some weeks later, and difficulties can arise unless accurate records are kept. The following principles might help:



image It is always wise to keep a patient’s property together and list it in detail as soon as possible in the property book on the ward (check hospital policy). Make a specific note of valuables such as money or jewellery.


image Note, too, if the patient is wearing or not wearing a watch or carrying any money so that there is a written record should any confusion arise.


image If the patient is unfit to make a decision, any valuables should be stored in a safe place in accordance with the hospital procedure (generally hospital property).


image If patients wish to remain in custody of their valuables they need to sign a disclaimer form that the trust cannot take responsibility for the loss of personal property and that it should be deposited in the hospital safe.


image A duplicate copy of the patient’s belongings list sent to the property office should always be given to the patient.


image Property should not be handed to relatives other than at the patient’s specific request and written documentation of this should be kept.


image When patients leave the department, all personal property should go with them, preferably in one large bag clearly labelled with name and destination. Receipts for any items taken into safe custody should be firmly attached to the notes or given to the patient if s/he is in a fit state.



Patients’ complaints


All patients have the right to make a complaint if they feel that their rights have been infringed and such complaints must be taken seriously. A formal complaint is usually made in the first instance to the hospital or community service involved, whether verbally or in writing, and is immediately reported to the senior manager who is responsible for investigating it. The patient and any staff involved are kept informed of any steps taken. Clinical complaints should be referred to the consultant in charge of the case who will discuss how it is to be handled with the senior manager.


Most complaints can be dealt with at a local level. When a complaint is likely to involve litigation, the health authority will seek legal advice and the staff concerned should be made aware of the help that is available to them through their professional association or trade union.


The complaints procedure usually involves the following steps:



1. The complaint will first be examined by the hospital or community services management before a decision is taken as to whether to refer the case to the nurse’s national board.


2. The board decides whether the case should be referred to the Professional Conduct Committee for nurses namely the Nursing & Midwifery Council (NMC).


3. The health service ombudsman may be involved when a patient feels a case has not been dealt with satisfactorily by the health authority.


4. The health service commissioner publishes an annual report.



Incident reporting


Incident reporting or unusual occurrence serves three main purposes (Smith et al. 2002) to:



image Help document quality of care. Not to be seen as a reprimand, but to show lead nurses areas of practice that need improvement.


image Identify areas where in-service education is needed.


image Record the details of an incident for possible legal reference, for example a situation that prevented a patient from a normal recovery. It is important to record all details of incidences when they occur on a ward, this should include:


– General details of the incident

– The patient’s response

– Your action or reaction to the incident

– A list of all personnel who were aware of the details of the incident.


Current government policy for UK care provision


The national standards for quality care (Department of Health 1999a) are placed under:



image The National Institute for Health and Clinical Excellence (NICE), www.nice.org.uk and www.cks.library.nhs.uk – three main areas:


– Public health

– The use of new technologies

– Medical care – care needs of people suffering from specific illnesses and conditions.

image National service framework (NSF), www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/index/htm sets national targets, identifies key interventions, and offers strategies and support for health organizations to improve standards and quality across healthcare sectors. NSFs were introduced to address variations in standards of care and to achieve consistency in the availability of services and best care to be provided to all. There are NSFs already developed in partnership with professionals, patients, carers, voluntary agencies, charities and other experts, e.g. cancer, children, coronary heart disease, diabetes, chronic obstructive airways disease, long-term conditions, mental health, older people and stroke. As a result good standards of patient care are promoted by using these guidelines.


image The “Making a difference” document emphasized the value of nursing, put forward the need to strengthen nurse education and training, improve the career structure (Department of Health 1999b):


– Nursing-led services

– Senior practitioners/consultant grades

– Qualifications for nurses, MSc – PhD.

image Healthcare Commission (formerly Commission for Health Improvement) Department of Health (2000):


– Helps governments to identify where developments are required

– Delivering to patients what they want: ‘a tailor made not mass produced, geared to the needs of users not the convenience of the producers’.

image Towards a strategy for nursing research and development (Department of Health 2000).


image The NHS plan – a 10-year programme of investment and reform that aims to secure an NHS that is fit for the 21st century (Department of Health 2001a) www.dh.gov.uk:


– Empower appropriately qualified nurses to undertake a wider range of tasks

– Services integrated around the needs of patients and communities.

image Working together – Learning together (Department of Health 2001a):


– Inter-professional education (IPE) – learning with other healthcare professionals to facilitate understanding of different practices and roles within health care

– Work-based learning (WBL) – emphasizing learning in the work place

– Life-long learning – learning should be lifelong and not just at undergraduate level

– Continued professional development (CPD) – updating knowledge and skills.

image Essence of care – arose from the commitment in ‘Making a difference’ to help improve the quality of essential aspects of care. The essence of care is to support the measures to improve quality of care, and help practitioners to take a structured approach in sharing and comparing practice. Draws on eight fundamental and essential aspects of care


(Department of Health 2001b):


– Personal and oral hygiene

– Food and nutrition

– Pressure ulcers

– Privacy and dignity

– Record keeping

– Safety of clients with mental health needs in acute mental health and general hospital settings

– Principles of self-care.

image Liberating the talents: helping primary care teams (PCTs) and nurses to deliver the NHS plan (Department of Health 2002a):


– Valuing generalist nurses with a variety of skills to offer in clinical practice

– Advanced and specialist skills in nursing whereby nurses are expert in a specialist field, e.g. pain or wound care

– New and creative ways of working

– Greater freedom and more flexibility in the work environment.

image The NHS knowledge and skills framework (Department of Health 2003), www.dh.gov.uk:


– Fair opportunities for continued professional development (CPD), pay and career progression

– Pay progression using the KSF will be linked to the ability of the individual to demonstrate that they have acquired knowledge and skills or promotion and accompanying increase in pay

– Involves personal development plans (PDP)

– Annual appraisal is mandatory.

image Choosing health – drawn from the view that traditional methods for improving health were becoming outdated (Department of Health 2004). A new approach to the public was required that responds to the needs of the individual. Underpinning principles are informed choice, personalization and working together. The priorities of action:


– Reduce the numbers of people who smoke

– Reduce obesity – new action with a focus on children

– Increase exercise – more opportunities

– Support sensible drinking

– Improve sexual health

– Improve mental health and wellbeing.

image Our health, our care, our say (Department of Health, 2006) – was devised to achieve the following:


– Better preventions services with earlier intervention

– Give people more choice and a louder voice

– To do more on tackling inequalities and improving access to community services

– Greater support for people with long-term needs.

image High quality care for all (Department of Health 2008):


– Lord Darzi’s review of the NHS highlighted the need for a shift in emphasis from a curative approach to health promotion as a key priority

– It required the appropriate primary health care trusts to provide health promotion services aligned to the specific needs of the local population.


2.2 Health and safety



Moving and handling


This may include putting down, pushing, pulling, carrying or moving. Any manual handling operation must meet two objectives:



1. The handler needs to employ minimal effort.


2. The patient must experience minimal discomfort.


These objectives can be achieved and the risk of injury reduced by undertaking a comprehensive assessment of the task’s requirements. Poor technique when handling patients can result in injury to the mover(s) and the patient. Risk assessment must be undertaken when manual handling cannot be avoided and there is a risk of injury.



When moving and handling people there is a risk of causing harm, a risk assessment needs to be undertaken as to the possible severity of that harm.


People handling risk assessment is the likelihood of a particular situation causing harm, taking into account the possible severity of that harm. People handling risk assessment should include the following and uses the acronym TILEE:



Task – the job to be undertaken, e.g. sit the patient up in the bed, walk the patient to the toilet, bed bath a patient, etc.


Individual – the nurse, and includes the skills/experience of the person(s) who is going to be involved and takes into consideration the height of nurses involved in the task.


Load – the patient is the load; involves ascertaining details of the patient’s weight and abilities:


image Ask the patient to raise their legs while sitting.

image What does the patient understand by simple commands?

image Why is the patient in hospital?

image Do they require analgesia before moving?

image Are there any drains, catheters, cardiac monitoring, trailing flexes?

Environment – consider the area surrounding the patient, what are the constraints, consider safety and trailing flexes.


Equipment – what is the most appropriate equipment to use, have the staff been trained in using it, what safety checks need to be carried out before using the equipment?


Ward staff need to do a risk assessment of the moving and handling needs before each moving and handling event and this must be documented and is part of the professional duty of care. It is important to remember that safe moving and handling impacts on all nursing activities, e.g. making a bed, wound dressings, taking a patient’s blood pressure and stocking shelves.


When suitable equipment such as hoists, small handling aids and electronic profiling beds are provided these should be used, well maintained, serviced, in good working order and placed close at hand.


Training and education in the use of manual handling equipment and practices should be an ongoing process with yearly updates for all staff. The aim is to have fewer nurses injured and to increase comfort and safety for patients. Factors that contribute to safer handling are:



image Trained, fit staff.


image Adequate supervision.


image Ergonomic assessments.


image Planned maintenance.


image Repair and replacement of equipment.


image Control of purchasing.


image Suitable and sufficient handling aids.


image Influencing attitudes of patients and relatives.


image Reporting and investigation of incidents.


image Competent agency staff.


image Sufficient staff.


Many patients may be able to move themselves or assist nurses while being moved and should be encouraged to help in ways compatible with their capabilities or health status.


The principles of safer manual handling are as follows:



image Assess unavoidable handling tasks and update assessment regularly.


image Channel the effort through your legs to protect your back.


image Move your feet in turn, not your body. Turn feet successively in the direction of movement (rather than twist at the waist).


image Bend your knees when appropriate but avoid overbending.


image Keep close to the load (when safe to do so).


image Maintain the natural curves of your spine and avoid twisting.


image Wear a uniform that allows unrestricted movement at shoulders, waist and hip, with non-slip shoes that provide support.


image Try to vary your tasks (so that different muscle groups are used in turn).


image Relax and move smoothly; avoid sudden movements.


image Remember to look after yourself with enough rest, suitable exercise and a healthy diet.


image If in doubt, seek advice. Do not risk it.



Violence and bullying



Violence


Violence towards staff members is any incident in which a health professional experiences abuse, threat, fear or the application of force arising out of the course of their work, whether or not they are on duty. The management of violence is necessary when the person:



image Shows a predisposition to violence.


image Makes a physical attack on another person or object.


image Becomes disturbed to the extent that their behaviour is considered a threat to their own safety and the safety of others.


The principles underlying the management of violent persons are as follows:



image Prevention of violent incidents is the foremost principle. This may not always be possible if physiological causes are the reason for the violence:


– brain tumours

– endocrine imbalance

– hyperthyroidism

– hyperglycaemia

– convulsive disorders

– HIV encephalopathy

– dementia

– neurological impairment

– alcohol/substance abuse

– pain

– side-effects of medication.

image Restraint is always therapeutic, never corrective, and where a one-to-one violent confrontation arises the best method is to use a breakaway technique.


image The risk of physical injury should be minimized; any restraint should be appropriate to the actual danger or resistance shown by the person.


image In all situations of violence, the locally agreed procedure for the nursing management of care of violent patients should be adhered to.


image Restraint may be necessary in certain situations but it is always therapeutic, never corrective.



When restraint is necessary the risk of physical injury should be minimized; any restraints should be appropriate to the actual danger or resistance shown by the person.




image The policy for violence should include:


– environmental and organizational factors

– anticipation and prevention of violence

– action following an incident.


Workplace bullying


The issue of bullying in the workplace is extremely prevalent yet remains under-researched in literature (Edwards & O’Connell 2007). Although bullying appears to be categorized under the classification of violence, numerous studies do appear to adopt it as an individual issue (Edwards and O’Connell 2007). Bullying is a form of violence. Without denial bullying exists in all areas of society, from toddlers to the very aged. It is not specific to gender, race, age or profession. Bullying can be subtle, indirect, direct or completely explicit. Regardless of its format, the consequences of bullying behaviour can be detrimental to nurses’ psychological and physiological wellbeing. Unfortunately bullying is rife in the healthcare sector, especially in the nursing profession.


The impact of bullying on the victim can have an enormous range of consequences including psychological and physical effects on the victim, impacting on his/her personal and professional life. Individual responses include people giving up their jobs to avoid the perpetrators, victims experiencing psychological stress, recurring nightmares, re-experiencing the trauma and moodiness, to name but a few.



Violence and bullying legislation, policies and guidelines


No employees of the NHS should have to experience any form of violence, aggression or bullying behaviour. There are various national and governmental policies, guidelines and legislation from 1974 to current day to protect them from such horrifying ordeals. The World Health Organization (WHO 2002) Guidelines for Addressing Workplace Violence and the National Health Service (National Health Service 1999) Zero Tolerance Policy are directly related to the issues of violence and bullying, both of which are described in detail below.


Resource sheets are also available for all employers in order for them to effectively implement the guidelines of the Zero Tolerance campaign. Procedures for dealing with aggressive patients, withholding treatment, developing local policies, development of counselling services for victims, dealing with complaints, methods of staff training and education against violence, how to record and monitor harassment and relevant legislation are all outlined in detail in the Zero Tolerance Zone pack and website. Employers and employees of all trusts should have access to this information, and members of the public should be made aware that any form of aggressive behaviour would not be tolerated.


Although in theory both of these published guidelines should be effective in practice, violence and bullying against staff still occur. The reasons why these policies are not working need to be further explored. Perhaps NHS staff are not aware of their existence or employers are choosing not to implement them in their trusts. Regardless, the issue of violence and aggression against healthcare professionals will not be reduced until it is dealt with appropriately.

Related posts:

  1. 1: Your job and its organization
  2. 3: Identification of patient problems
  3. 4: Fundamental procedures
  4. 5: A systems approach

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Jun 15, 2016 | Posted by in NURSING | Comments Off on 2: Principles of adult nursing

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