Developing competence for person-centred nursing in the community

CHAPTER AIMS

• To show how the NMC standards for competence that all nurses are required to achieve for registration underpin safe, effective and person-centred care

• To use a scenario focusing on the care needs and experience of an individual and his family to enable the student to reflect on your learning experience in the community

• To help the student to use your learning experience to best effect in evidencing achievement of your learning outcomes for this placement

Introduction

This final chapter will help you to consolidate your learning from previous chapters and your experience from practice learning in the community. A scenario is used to describe a situation that is not unusual in the community. It illustrates the impact that the needs and experience of one family member can have on the other members of the family.

However, the scenario also illustrates how the four domains of the NMC competency framework underpin nursing practice:

1. Professional Values

2. Communication and Interpersonal Skills

3. Nursing Practice and Decision-making

4. Leadership, Management and Teamwork.

The NMC competencies and essential skills will be evident in the learning outcomes that you have been working towards throughout your placement. Working through the questions associated with each part of the scenario will enable you to relate your responses to these learning outcomes and may be helpful in developing evidence of learning for your portfolio.

Scenario

Margaret and Harry: Part 1 – Introduction to their life and health

Margaret and Harry have been married for 52 years. Harry was the head teacher at the local high school and Margaret was a part-time librarian. They moved to a modern bungalow to be nearer their daughter Alison when her first baby was born 10 years ago. Margaret and Harry had lots of interests: Harry was passionate about his garden and was a member of the local historical society and Margaret ran a book club and was very involved in helping to look after their grandchildren. Margaret and Harry also have two sons who both live in Australia and they have spent extended holidays there.

Five years ago, Harry was diagnosed with Alzheimer’s disease. Slowly but surely, their lives have changed as Harry’s physical and mental health have deteriorated. It is a while since they have been active in their local community and they have become quite isolated. Harry’s short-term memory is now very poor and he is no longer able to go out on his own. He requires supervision most of the time and guidance with most daily activities such as washing, dressing and shaving. Sometimes he becomes extremely frustrated by this and gets angry with Margaret on whom he relies completely.

Activity

Question 1

How might Harry be feeling living with dementia?

What impact do you think caring for Harry would have on Margaret’s health and wellbeing?

If you were visiting Margaret and Harry during your community placement what could you do to understand more about Harry’s feelings and Margaret’s role?

At the heart of person-centred care is trying to understand the person’s perspective and how their condition affects their life and relationships. It may be difficult for Harry to express how he feels at this point in his illness but it may not be difficult to pick up cues. Carers are often very good at this and can interpret behaviour, such as anger and aggression, as fear, frustration and confusion.

Activity

Access the Alzheimer’s Society website, at: http://www.alzheimers.org.uk/ and read about how Alzheimer’s can affect the individual and their family.

Discussions throughout the book have made reference to the experiences of carers. Chapter 5 in particular, looks at the impact that caring can have on physical and psychological health.

Let us say that in Margaret and Harry’s scenario, Margaret wants to care for her husband; she knows he receives the care he wants and needs, and she wants him to be happy at home. So in this respect, the carer’s role brings her pleasure, satisfaction and reassurance. But she is also exhausted, isolated, frustrated and risks developing health problems of her own. In many ways, it is the caring role itself and not what the role involves in terms of the condition or specific needs of the person being cared for that makes the impact. However, caring for someone with dementia has some unique challenges. It is difficult for those on the periphery to fully appreciate the carer’s experience. But an empathetic approach of trying to put oneself in the carers’ shoes is vitally important in order to offer carers the help and support they need and not what the services they think they need.

Activity

Read the following article to gain some insight into how a nursing student supported a person with dementia and their carer in the community: Roy D, Gillespie M (2011) Who cares for the carers? A student’s experience of providing carer support and education. British Journal of Nursing 20(8):484–488.

If you were visiting Margaret and Harry, the following are some of the ways that could help you understand Margaret’s perspective:

• Ask Margaret if you could spend some time with her to ask her about her experience of caring for Harry.

• Ask Margaret if you could spend a day with her to experience ‘a day in the life of a carer’ (see below).

• It might be difficult for Harry to express his feelings but you could find out more about Alzheimer’s disease and other forms of dementia (see Chapter 8 and Further reading at the end of the chapter).

• Learn more about the real life experience of other carers. ‘Keeping mum’, gives insight into the carer’s experience and is an account of Marianne Talbot’s own challenges of caring for her mother at home (Talbot 2011).

Professional values underpin this aspect of nursing practice. The NMC generic standard for competence in Domain 1: Professional Values, includes ‘safe, compassionate, person-centred, evidence-based care that respects dignity and human rights’ (NMC Competencies for entry to the register: NMC 2010: 13).

Activity

Identify the learning outcomes for this placement that are associated with the competencies in NMC Standards Domain 1: Professional Values and the Essential Skills Cluster: Care, Compassion and Communication. Have you made the most of opportunities that nursing in the community provides to develop positive working and therapeutic relationships and nursing practice, which is based on respect for individuals, their values, choices and diversity? What further experience would enable you to evidence learning that relates to your learning outcomes in this area? Discuss with your mentor opportunities to spend a day with a family on the caseload and experience first-hand ‘a day in the life of a carer’. This would be an excellent opportunity to develop the skills, knowledge and attitudes required in this domain and evidence your learning in your portfolio.

Access and read the Queen’s Nursing Institute publication ‘Nursing People at Home’, at: http://www.qni.org.uk/docs/RNRS_report_WEB.pdf

The skills that people valued most in the community nurse visiting them at home were competence and confidence and essentially person-centred caring, which involved sensitivity and compassion and demonstrated understanding and support for all members of the family. (QNI 2011)