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A discussion took place with Nick, whose name has been changed to respect confidentiality as enshrined in The Code (Nursing and Midwifery Council (NMC) 2008). Nick, a gentleman, aged 51, was admitted to hospital with vomiting and acute abdominal pain. Nick’s experience of admission, examination and testing were mainly positive. Nick’s postoperative experiences were extremely negative. Most aspects of The Code (NMC 2008) were observed on admittance nonetheless, it appears that little of The Code was applied postoperatively.
This essay will examine the positive and negative aspects of Nick’s hospital care and employ psychosocial models to critique Nick’s care. On admission, Nick felt valued and confident when his doctor formatted appropriate questions for his current concern and established Nick’s prior history. Nonetheless, as suggested by Heritage & Maynard (2008), Nick felt too much time was spent in discussion of a prior chronic condition. Conversely, Nick appreciated the need for the doctor to rule out a possible re-occurrence of a previous condition.
As required by the NMC (2008) Nick gave informed consent prior to any testing or examination; Nick’s dignity was preserved as described by Cass et al. (2008) and he felt reassured throughout. Nick was diagnosed with acute appendicitis and admitted to a ward to await surgery. Peate (2008) suggests once a diagnosis has been reached it is important for analgesia to be provided. The doctor responded to Nick’s needs and provided appropriate antiemetic and analgesic medication. Nick awoke postoperatively in considerable pain and discomfort and very thirsty. Cooper et al. 2004) consider that fundamental aspects to patient care are the relief of pain and suffering, yet Nick found himself lying alone on a trolley in a corridor, in considerable pain and very thirsty. Nursing staff were not evident and no bell was within reach. A drip was attached to Nick’s left arm, and there were no curtains or screens surrounding him. Denied an area to safely provide privacy (Department of Health 2003) Nick felt undervalued. Nick removed his drip and walked in a backless gown to find help. Nick found a bell, rang it and waited for over an hour before a nurse arrived.
When a nurse appeared, Nick asked for some water and expressed concern about his pain. The nurse returned Nick to his trolley, but did not address the potential harm of not re-attaching his drip (NMC 2008). The nurse checked the chart and told Nick he could have 2 paracetamol every 4 hours. Nick requested stronger pain relief; the nurse told Nick that this would require a doctor. Nick believed the nurse left him, in order to consult a doctor to prescribe more medication and to bring some water to ease Nick’s thirst. Nick felt reassured that his needs would soon be met.
Making the care of people your first concern is a prerequisite for a nurse (NMC 2008). After surgery, Nick’s primary needs for thirst and pain relief remained unmet. Because the nurse failed to return after a further 1. 5 hours, Nick took his care and welfare into his own hands. Nick discovered the room he had been admitted into was now occupied, but his clothing remained in the locker by the patient’s bed, so Nick retrieved his clothing, got dressed and left the hospital. As a direct result of Nick’s failure to receive water or pain relief, Thompson (2003) citing Charon et al. 1996) argues that Nick’s loss of trust in the hospital, his abandonment of his treatment, his questioning of the nurse’s integrity and his walking 6 miles home, in the early hours, endangering his recovery, is evidence of Nick’s underlying values, such as a desire for information, personal control, and recognition of individuality. Whilst Nick’s experience of postoperative care did not match appropriate NMC (2008) standards, this may have been due to other considerations; however Nick described himself as “meat on a slab”.
Postoperatively, Nick did not feel as though he was treated as an individual or accorded appropriate respect and dignity. According to Race and Wolfensburger (2003), Nick was devalued and experienced unacceptable levels of care, whilst Darzi (2008) maintains that people experience less loneliness and isolation when they receive highly superior care services that respect people’s dignity. Nick felt being left alone in a corridor, on a hospital trolley, thirsty and in pain, did not meet standards of superior quality care.
It can be argued that Nick’s postoperative experiences could have been significantly improved had there been a staff member available to attend to his needs. Because the nurse was initially unavailable and unable to prescribe pain relief, her duty was to make a referral to another practitioner (NMC 2008). Since no other practitioner attended Nick to prescribe pain relief, it appeared to Nick that the nurse failed in her duty. According to Peate (2008) Nick’s vital signs should have been monitored postoperatively, and pain managed effectively.
Nick’s immediate need for water and analgesia should have been met, and his drip re-attached. Nick received neither verbal reassurance, nor, more importantly, adequate explanation concerning why his needs were being untreated. Nick’s thirst was not satisfied with a basic human right such as water and Article 8 of the Human Rights Act (1998) also states, a person has the right to privacy, yet Nick’s privacy had been compromised. Nick’s bed was currently occupied, ostensibly denying him access to the facilities of that room however; Nick entered the room to retrieve his personal possessions.
Wondrak (2001) suggests that unconscious negative feelings may trigger a powerful transference reaction towards a carer. Reassurance and a timely response from a nurse may have restored a more positive outlook for Nick, thereby avoiding his subsequent decision to leave the hospital. Superior quality care should have been offered to Nick and, had he been in receipt of such care, Nick’s stay in hospital may have resulted in a positive outcome.
Mistakes in care happen, and whilst codes exist to assist nurses to develop best care practice to prevent oversights from happening, it is clear from this essay that Nick experienced two separate and distinct levels of care. In studying and researching different care models, I have begun to appreciate ‘the dos and don’ts’ behind best care practice, and the need to develop excellent communication skills. Examining Nick’s experiences has led me to appreciate more fully the responsibility that patients place upon nurses for their care.
This study has reinforced my need both for vigilance and diligence within every aspect of professional nursing. Wondrak (2001) suggests that to become a skilled carer, I need to be able to retain awareness of the need to improve my technical skills without losing touch with the holistic needs of the patient as a human being. References Bradley E. , Campbell P. & Nolan P. (2005) Nurse prescribers: who are they and how do they perceive their role? Journal of Advanced Nursing. 51 (5), pp. 439-448. Cass E. , Robbins D. , Richardson A. (2008) Adults’ Services Practice Guide 9 Dignity in Care.
Social Care Institute for Excellence. Available from http://www. scie. org. uk/publications/practiceguides/practiceguide09. Accessed on 13th Oct 2008. Charon R. , Banks J. T. , Connelly J. E. , Hawkins A. H. , Hunter K. M. , Jones A. H. (1995) Literature and medicine: contributions to clinical practice. Annals of Internal Medicine. 122(8), pps. 599-606. Cooper J. G. , Haetzman M. , Stickle B. R. (2004) Effective post-operative analgesia. The Surgeon. (Educational Review). http://www. edu. rcsed. ac. uk/lectures/lt38. htm accessed 26th September 2008
Department of Health (2003) Essence of Care: Patient-focused benchmarks for clinical governance. NHS Modernisation Agency. Stockport. 4127915. pps. 120- 127. Available from: http://www. dh. gov. uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4005475 accessed on 29th September 2008. Department of Health (2008) Human Rights in Healthcare A framework for local action. Central Office of Information. Available from: http://networks. csip. org. uk/_library/Human_Rights_in_Healthcare. pdf. Accessed on 22nd Oct 2008 Heritage J. & Maynard D. W. (eds. ) (2008) Communication in Medical Care.
Interaction between primary care physicians and patients. Cambridge University Press. p. 184. Hughes S. (2002) The effects of giving patients preoperative information. Nursing Standard. 16(28), pp. 33???7. Mason T. , Carlisle C. , Watkins C. , Whitehead E. , (eds. ) (2001) Stigma and Social Exclusion. Routledge. Nursing & Midwifery Council (2008). The Code. Standards of conduct, performance and ethics for nurses and midwives. Peate I. (2008) Caring for people with appendicitis. British Journal of Healthcare Assistants. 2(8), pp. 389 ??? 392. Professor the Lord Darzi of Denham KBE (2008) High Quality Care For All.
NHS Next Stage Review final report. The Stationery Office. Available from: http://www. dh. gov. uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/DH_085825 accessed on 30 September 2008 Race D. G. (ed. ) (2003) Leadership and Change in Human Services Selected Readings from Wolf Wolfensberger. Routledge. p. 33. Thompson T. L. , Dorsey A. M. , Miller K. I. , Parrott R. (2003) Handbook of Health Communication. Lawrence Erlbaum Associates. p. 141. Wondrak R. (2001) Interpersonal Skills for Nurses & Health Care Professionals. Blackwell Science.